Provider Demographics
NPI:1679128631
Name:ROACH, JAIME KATHLEEN (LCSW)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:KATHLEEN
Last Name:ROACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:KATHLEEN
Other - Last Name:QUILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:441 NW W HWY
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64061-9117
Mailing Address - Country:US
Mailing Address - Phone:816-308-0246
Mailing Address - Fax:
Practice Address - Street 1:1525 N HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080-1972
Practice Address - Country:US
Practice Address - Phone:816-308-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO202440468441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical