Provider Demographics
NPI:1831232164
Name:ROTHWEILER, MICHAEL R (MSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:ROTHWEILER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 149TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE X
Mailing Address - State:MN
Mailing Address - Zip Code:55304-6433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 SUMMER ST NE
Practice Address - Street 2:UNIVERSITY DAY COMMUNITY
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2820
Practice Address - Country:US
Practice Address - Phone:612-627-4107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8972104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker