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General NPI Number Information
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NPI Number | 1104686849
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Entity Type | Organization
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Legal Business Name | TENA ROETHLE
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Dates
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Enumeration Date | 03/20/2024
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 400 WASHINGTON ST STE 229
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City | NORTHFIELD
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State | MN
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Zip | 55057-2027
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Country | US
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Telephone | 507-951-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 400 WASHINGTON ST STE 229
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City | NORTHFIELD
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State | MN
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Zip | 55057-2027
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Country | US
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Telephone | 507-951-8500
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Fax |
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Authorized Official
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Title or Position | OWNER/LICSW
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Name | TENA ROETHLE
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Credential | LICSW
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Telephone | 507-222-9230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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