Provider Demographics
NPI:1679157408
Name:ROESLER, COURTNIE JEAN (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:COURTNIE
Middle Name:JEAN
Last Name:ROESLER
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 E GATEWAY CIR S APT 101
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3651
Mailing Address - Country:US
Mailing Address - Phone:701-540-1500
Mailing Address - Fax:
Practice Address - Street 1:4500 36TH AVE S STE 200
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5275
Practice Address - Country:US
Practice Address - Phone:701-532-1507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist