Ethan Bjorn Roe

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

1900 Silver Lake Rd NW Ste 110
New Brighton, MN 55112-1789

Phone

(651) 419-4351

Fax

(651) 628-0411

NPI assigned

May 20, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1134968175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 MAJOR DR N",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224153",
            "telephone_number": "612-860-5737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW STE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121789",
            "telephone_number": "651-419-4351",
            "fax_number": "651-628-0411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROE",
        "first_name": "ETHAN",
        "middle_name": "BJORN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-20",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jade Richter
• Jessica Eleanor Rick, PSYD, LP
• Susan Sorensen Ripp, RD, LD
• Eleanor Claire Rizor
• Russell Robbins, LADC
• Leanne Rohlf, APNP
• Matthew Joseph Rommel, LADC
• Ronald H Vescio DDS
• Asher Stoen Rooks
• Rose Home Care LLC

• Counselor in New Brighton, MN
• Providers in New Brighton, MN by specialty
• Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.