Provider Demographics
NPI:1316906134
Name:ROHRET-ERICKSON, TERESA J (RN, LISW)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:J
Last Name:ROHRET-ERICKSON
Suffix:
Gender:F
Credentials:RN, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 TIMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-8256
Mailing Address - Country:US
Mailing Address - Phone:712-240-3931
Mailing Address - Fax:515-232-2775
Practice Address - Street 1:600 5TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6085
Practice Address - Country:US
Practice Address - Phone:515-232-2051
Practice Address - Fax:515-232-2775
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA09023Medicare ID - Type Unspecified
IAR02967Medicare UPIN