Alicia Blair Roeder, MS

Primary specialty

CounselorTaxonomy code 101Y00000X

License

9223 Issued in NE

Practice address

1070 Deveron Dr
Council Bluffs, IA 51503-1022

Phone

(712) 309-1594

NPI assigned

Jun 3, 2011

Sex

Female

Sole proprietor

Yes

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

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Birch Grove Counseling

  • Counselor
  • Council Bluffs, IA
  • NPI 1386598498
  NPD Authorized official

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

{
    "created_epoch": "1307059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1366736688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 DEVERON DR",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515031022",
            "telephone_number": "712-309-1594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1070 DEVERON DR",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515031022",
            "telephone_number": "712-309-1594"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1413 S Washington St",
            "address_purpose": "LOCATION",
            "city": "Papillion",
            "state": "NE",
            "postal_code": "680464165",
            "country_code": "US",
            "telephone_number": "402-320-0867",
            "fax_number": "402-827-0011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROEDER",
        "first_name": "ALICIA",
        "middle_name": "BLAIR",
        "credential": "MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-03",
        "last_updated": "2023-07-24",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NE",
            "license": "9223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Counselor in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; 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.