Provider Demographics
NPI:1992406359
Name:ROERICK, DONNA (CERTIFIED HEALTH COA)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:ROERICK
Suffix:
Gender:F
Credentials:CERTIFIED HEALTH COA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 32ND AVE S
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301
Mailing Address - Country:US
Mailing Address - Phone:320-333-5396
Mailing Address - Fax:
Practice Address - Street 1:32 32ND AVE S
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-5630
Practice Address - Country:US
Practice Address - Phone:320-333-5396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach