Healthcare Provider Details

I. General information

NPI: 1326437385
Provider Name (Legal Business Name): ALEX ROEDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3285 FIECHTNER DR S STE B
FARGO ND
58103-2490
US

IV. Provider business mailing address

3285 FIECHTNER DR S STE B
FARGO ND
58103-2490
US

V. Phone/Fax

Practice location:
  • Phone: 701-361-8273
  • Fax: 701-301-8205
Mailing address:
  • Phone: 701-361-8273
  • Fax: 701-301-8205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4250
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: