Healthcare Provider Details

I. General information

NPI: 1366387367
Provider Name (Legal Business Name): MINDI JO ROTERT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 PACIFIC AVE STE 1
AUDUBON IA
50025-1056
US

IV. Provider business mailing address

515 PACIFIC AVE STE 1
AUDUBON IA
50025-1056
US

V. Phone/Fax

Practice location:
  • Phone: 712-563-5285
  • Fax: 712-563-5277
Mailing address:
  • Phone: 712-563-5285
  • Fax: 712-563-5277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number137765
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: