MEDICARE: JENNIFER L ROORDA MSW, LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	32193	MN

General Provider Information

NPI Number	:	1720912249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L ROORDA MSW, LICSW

Provider Business Mailing Address
First Line	:	2429 121ST CIR NE UNIT K
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55449-5588
Country	:	US
Telephone Number	:	763-258-7734
Fax Number	:	763-688-7781

Provider Business Practice Location Address
First Line	:	701 DELLWOOD ST S
Second Line	:
City	:	CAMBRIDGE
State	:	MN
Zip	:	55008-1917
Country	:	US
Telephone Number	:	763-688-8208
Fax Number	:	763-688-7781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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