Active NPI
Lori Roetlin
- Clinical Social Worker
- Coralville, IA
National Provider Identifier
1619519600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 04814
- Practice address
- 2350 Oakdale Blvd
Coralville, IA 52241-9702 - Phone
- (319) 351-5437
- NPI assigned
- Oct 11, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 04814 | IA | Primary |
Addresses
Primary practice location
2350 Oakdale Blvd
Coralville, IA 52241-9702
Mailing address
1930 Lynncrest Dr
Coralville, IA 52241-2714
Phone (319) 430-0698
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04814 | IA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Childserve Therapy, Inc. | Past | Accepting new patients | |
| The Childserve Clinic Inc | Clinical | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Physical Therapist
- Johnston, IA
- NPI 1679614754
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570752000000",
"number": "1619519600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1930 LYNNCREST DR",
"city": "CORALVILLE",
"state": "IA",
"postal_code": "522412714",
"telephone_number": "319-430-0698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2350 OAKDALE BLVD",
"city": "CORALVILLE",
"state": "IA",
"postal_code": "522419702",
"telephone_number": "319-351-5437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROETLIN",
"first_name": "LORI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-11",
"last_updated": "2019-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IA",
"license": "04814",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coralville, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.