=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356220701
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WHITNEY MARIE ROEDER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2025
-----------------------------------------------------
Last Update Date | 08/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2325 CLEMENT AVE STE A
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94501-7061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-393-6720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 CLEAVELAND RD APT 52
-----------------------------------------------------
City | PLEASANT HILL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94523-3885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-393-6720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------