Provider Demographics
NPI:1881203263
Name:ROEDDER, LINDA I
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:I
Last Name:ROEDDER
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 1:275 PRINCESS KATE CIR
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2885
Mailing Address - Country:US
Mailing Address - Phone:857-251-2540
Mailing Address - Fax:
Practice Address - Street 1:275 PRINCESS KATE CIR
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2885
Practice Address - Country:US
Practice Address - Phone:857-251-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN131782364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent