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General NPI Number Information
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NPI Number | 1861347080
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Entity Type | Individual
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Provider Name | RISA LORENA ROTH M.ED.
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Gender | Female
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 1422 W LAKE ST STE 314
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2616
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Country | US
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Telephone | 612-445-0225
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Fax | 612-445-0112
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Provider Business Mailing Address
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Address Line | 720 N 4TH ST UNIT 206
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City | MINNEAPOLIS
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State | MN
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Zip | 55401-1945
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Country | US
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Telephone | 847-962-1570
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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