Healthcare Provider Details

I. General information

NPI: 1720912249
Provider Name (Legal Business Name): JENNIFER L ROORDA MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DELLWOOD ST S
CAMBRIDGE MN
55008-1917
US

IV. Provider business mailing address

2429 121ST CIR NE UNIT K
BLAINE MN
55449-5588
US

V. Phone/Fax

Practice location:
  • Phone: 763-688-8208
  • Fax: 763-688-7781
Mailing address:
  • Phone: 763-258-7734
  • Fax: 763-688-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32193
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: