Susan Rose Roeller, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

17878 Issued in MN

Practice address

1930 Coon Rapids Blvd NW
Coon Rapids, MN 55433-4708

Phone

(763) 427-7964

Fax

(763) 427-7976

NPI assigned

Feb 23, 2011

Last updated

Feb 23, 2011By the provider in NPPES

Sex

Female

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

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2005

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Lyn-Lake Psychotherapy and Wellness LTDGroup PAC ID 9638581291, 72 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Lyn-Lake Psychotherapy and Wellness LTD.

  • Clinical Psychologist
  • Minneapolis, MN
  • NPI 1609355163
  Medicare reassignment Care Compare group NPD
• Tubman

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Minneapolis, MN
  • NPI 1376655159
  Medicare reassignment NPD
• DBT and Emdr Specialists, P.a.

  • Community/Behavioral Health Agency
  • Elk River, MN
  • NPI 1750774162
  NPD
• Psychological Healthcare, PLLC

  • Professional Counselor
  • Syracuse, NY
  • NPI 1922109578
  NPD (past)

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

{
    "created_epoch": "1298419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298419200000",
    "number": "1801193123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334708",
            "telephone_number": "763-427-7964",
            "fax_number": "763-427-7976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334708",
            "telephone_number": "763-427-7964",
            "fax_number": "763-427-7976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROELLER",
        "first_name": "SUSAN",
        "middle_name": "ROSE",
        "name_prefix": "Ms.",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-23",
        "last_updated": "2011-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "17878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeff Roberg, DO
• Robert B. Henson DDS PLLC (Osage Dental Associates)
• Zakiya Robertson
• Michael Rodriguez, PT
• Rufino R Rodriguez, MD
• James Roemer, PHARMD
• Arisa Roettger
• Roger E Austin, DDS, PA (Foley Dental Clinic)
• Walker Mitchell Rogers
• David Farris Rogge, M.A., L.A.D.C.

• Clinical Social Worker in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.