DR. KENNETH DAVID ROACH (NPI# 1619189628) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619189628 |
| Entity Type | Individual |
| Full Name | DR. KENNETH DAVID ROACH |
| Credential | LCMHC |
| Practice Address |
4190 S Highland Dr Ste 210 Salt Lake City UT 84124-2674 |
| Mailing Address |
1131 Loch Lomond Way Salt Lake City UT 84117-4974 |
| Practice Telephone | 8017927028 |
| Mailing Telephone | 8012811078 |
| Mailing Fax Number | 8012697565 |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2018-10-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
4909154-6004 | UT | Behavioral Health & Social Service Providers |
| Y | 101YP2500X |
Counselor Specialization: Professional |
4909154-6004 | UT | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 451 E 1000 S Ste B, Pleasant Grove, UT 840623735 | 8017927028 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922561745 | Kenneth Wayne Roach | Specialist | 15650 Walden Rd Apt 4302, Montgomery, TX 77356-1780 | 2019-04-09 |
| 1780686014 | Kenneth William Roach | Ophthalmology | 1000 N Main St, Suite #204, Fuquay Varina, NC 27526-2056 | 2005-05-31 |
| 1053630673 | Kenneth Lee Roach | Internal Medicine | 3300 Gallows Road, Department of Medicine, Falls Church, VA 22042 | 2010-05-21 |
| Street Address |
4190 S HIGHLAND DR STE 210 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84124-2674 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033684618 | Midtown Counseling | Counselor | 4190 S Highland Dr Ste 210, Salt Lake City, UT 84124-2674 | 2018-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487273298 | Shannon Penny Price | Social Worker | 4465 Maybeck Place, Condo C, Millcreek, UT 84124 | 2020-04-11 |
| 1922654367 | Joseph C Melvin Md PC | Colon & Rectal Surgery | 1250 East 3900 South Ste 320, Salt Lake City, UT 84124 | 2019-08-12 |
| 1366923252 | Melanie Stumpf | Counselor | 1141 E 3900, Suite A170, Salt Lake City, UT 84124 | 2018-08-28 |
| 1376033993 | Michelle Flowers | Speech-Language Pathologist | 2120 East 3900 South, Ste 200, Holladay, UT 84124 | 2018-05-18 |
| 1740797257 | Lissa Anne Hutchings | Nurse Practitioner | 1160 E 3900 S Ste 4100, Salt Lake City, UT 84124 | 2018-01-05 |
| 1316465693 | Randy Gines | Counselor | 4460 S Highland Drive # 230, Murray, UT 84124 | 2017-09-06 |
| 1417470717 | Joshua Chandler Spencer | Counselor | 4460 South Highland Dr., 230, Murray, UT 84124 | 2017-07-19 |
| 1659891554 | Marcus Whitney | Counselor | 4460 S Highland Dr. # 230, Murray, UT 84124 | 2017-06-21 |
| 1518496884 | Courtney Nilson | Counselor | 4460 S. Highland Dr. #230, Murray, UT 84124 | 2017-06-08 |
| 1841687126 | Intrafilrx | Preferred Provider Organization | 3920 S 1100 E Ste 210, Salt Lake City, UT 84124 | 2015-04-23 |
| Find all providers in zip 84124 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902368640 | Jennifer Elizabeth | Counselor | 1583 S 1600 E, Salt Lake City, UT 84105-2829 | 2019-04-02 |
| 1487114138 | Kara Kristine Groicher | Counselor | 525 E 100 S Ste 320, Salt Lake City, UT 84102-4210 | 2019-03-20 |
| 1649644428 | Naomia Bell | Counselor | 5965 S 900 E Ste 430, Salt Lake City, UT 84121-1720 | 2015-11-17 |
| 1033506464 | Maikel Hernandez | Counselor | 207 E Williams Ave, Salt Lake City, UT 84111-4625 | 2015-04-23 |
| 1619242062 | Martin Lynn Macdonald | Counselor | 2872 S. Highland Drive, Touchstone Therapy Center, Salt Lake City, UT 84106 | 2012-03-19 |
| 1447522297 | Ivana Juarez | Counselor | 570 N 200 W, Apt 9, Salt Lake City, UT 84103-1334 | 2012-02-08 |
| 1891085346 | Randall Ann Smith | Counselor | 160 S 600 E, #300, Salt Lake City, UT 84102-1962 | 2011-04-17 |
| 1497054829 | Alyson R Ainscough | Counselor | 2549 Melbourne St, Salt Lake City, UT 84106-4003 | 2011-03-24 |
| 1144527243 | Crystal Nicole Garduno | Counselor | 1522 South 1100 East, Salt Lake City, UT 84105 | 2011-02-25 |
| 1215242003 | Edward Paul France | Counselor | 125 W Burton Ave, Salt Lake City, UT 84115-2610 | 2010-08-17 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84124 |
Please comment or provide details below to improve the information on DR. KENNETH DAVID ROACH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.