Provider Demographics
NPI:1821223793
Name:ROETHLE, TENA BUELL (LICSW)
Entity Type:Individual
Prefix:
First Name:TENA
Middle Name:BUELL
Last Name:ROETHLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:TENA
Other - Middle Name:BUELL
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:400 WASHINGTON ST # 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:507-222-9230
Mailing Address - Fax:952-831-0033
Practice Address - Street 1:400 WASHINGTON ST # 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:507-222-9230
Practice Address - Fax:952-831-0033
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLGSW152421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical