JENNIFER ROACH (MA, LCMHC) – Addiction (Substance Use Disorder) Counselor, NPI 1003247677
Addiction (Substance Use Disorder) Counselor
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Profile Insights
NPPES metrics only — not quality of care.
356 MENTAL HEALTH COUNSELOR in UT
Provider Addresses for JENNIFER ROACH (MA, LCMHC)
132 E SEGO LILY DR APT 110
SANDY, UT 840704260
Phone: (206) 427-7754
Type: Mailing
342 S 850 W APT 306
AMERICAN FORK, UT 840034654
Phone: (206) 427-7754
Fax: (425) 258-5275
Type: Location
2610 WETMORE AVE
EVERETT, WA 982012927
Phone: (425) 258-5270
Fax: (425) 258-5275
Type: Mailing
1076 W 1275 S
SPRINGVILLE, UT 846635060
Phone: (206) 427-7754
Type: Mailing
19529 34TH DR SE
BOTHELL, WA 980127984
Phone: (206) 427-7809
Fax: (425) 258-5275
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-06-09
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20240609000192 | I | Mental Health Counselor | UT | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 84070)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Mental Health Counselor | ID |
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