| Tena Roethle | |
|
400 Washington St Ste 229 Northfield MN 55057-2027 | |
| (507) 951-8500 | |
| Not Available |
| Full Name | Tena Roethle |
|---|---|
| Speciality | Social Worker |
| Location | 400 Washington St Ste 229, Northfield, Minnesota |
| Authorized Official Name and Position | Tena Roethle (OWNER/LICSW) |
| Authorized Official Contact | 5072229230 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tena Roethle 400 Washington St Ste 229 Northfield MN 55057-2027 Ph: (507) 951-8500 | Tena Roethle 400 Washington St Ste 229 Northfield MN 55057-2027 Ph: (507) 951-8500 |
| NPI Number | 1104686849 |
|---|---|
| Provider Enumeration Date | 03/20/2024 |
| Last Update Date | 03/20/2024 |
| Certification Date | 03/20/2024 |
| Medicare PECOS PAC ID | 5991144503 |
|---|---|
| Medicare Enrollment ID | O20240416001398 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104686849 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tena B Roethle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821223793 PECOS PAC ID: 5799941845 Enrollment ID: I20120718000517 |
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