Healthcare Provider Details

I. General information

NPI: 1477954550
Provider Name (Legal Business Name): REBECCA ROEPKE MSW, MA, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 E 82ND ST STE 325
BLOOMINGTON MN
55425-1386
US

IV. Provider business mailing address

2626 E 82ND ST STE 325
BLOOMINGTON MN
55425-1386
US

V. Phone/Fax

Practice location:
  • Phone: 651-237-2171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23297
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: