Provider Demographics
NPI:1104686849
Name:TENA ROETHLE
Entity type:Organization
Organization Name:TENA ROETHLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICSW
Authorized Official - Prefix:
Authorized Official - First Name:TENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROETHLE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:507-222-9230
Mailing Address - Street 1:400 WASHINGTON ST STE 229
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2027
Mailing Address - Country:US
Mailing Address - Phone:507-951-8500
Mailing Address - Fax:
Practice Address - Street 1:400 WASHINGTON ST STE 229
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2027
Practice Address - Country:US
Practice Address - Phone:507-951-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty