Healthcare Provider Details

I. General information

NPI: 1033907415
Provider Name (Legal Business Name): AMBER ROERICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4324 UNIVERSITY AVE STE B
GRAND FORKS ND
58203-1938
US

IV. Provider business mailing address

10111 MORRISON LINE RD
FREEPORT MN
56331-9038
US

V. Phone/Fax

Practice location:
  • Phone: 701-746-4584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: