Provider Demographics
NPI:1598001695
Name:ROELIKE, LEANNE JEAN
Entity Type:Individual
Prefix:MISS
First Name:LEANNE
Middle Name:JEAN
Last Name:ROELIKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14501 GRANADA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6315
Mailing Address - Country:US
Mailing Address - Phone:952-431-3003
Mailing Address - Fax:952-431-3016
Practice Address - Street 1:14501 GRANADA DR STE 101
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6315
Practice Address - Country:US
Practice Address - Phone:952-431-3003
Practice Address - Fax:952-431-3016
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist