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General NPI Number Information
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NPI Number | 1750722195
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Entity Type | Individual
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Provider Name | CRAIG MARTIN ROELKE PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 6063 HUDSON RD SUITE 200
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City | WOODBURY
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State | MN
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Zip | 55125-4454
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Country | US
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Telephone | 952-460-9022
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Fax | 651-714-9029
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Provider Business Mailing Address
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Address Line | 906 CONCORDIA AVE
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City | SAINT PAUL
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State | MN
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Zip | 55104-5418
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Country | US
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Telephone | 612-810-3683
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP5636
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License Number State | MN
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