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General NPI Number Information
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NPI Number | 1902068125
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Entity Type | Individual
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Provider Name | SUSAN MARIE ROERS LICSW
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Gender | Female
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Dates
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Enumeration Date | 06/29/2008
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 5555 BOONE AVE N
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City | NEW HOPE
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State | MN
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Zip | 55428-3636
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Country | US
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Telephone | 651-774-0011
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Fax | 651-774-0606
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Provider Business Mailing Address
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Address Line | 3000 AMES CROSSING RD STE 600
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City | EAGAN
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State | MN
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Zip | 55121-2570
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Country | US
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Telephone | 651-774-0011
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Fax | 651-774-0606
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 301571
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 20099
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License Number State | MN
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