Provider Demographics
NPI:1730128133
Name:LIEBERG JORDHEIM, ROXANA D (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:D
Last Name:LIEBERG JORDHEIM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ROXANA
Other - Middle Name:D
Other - Last Name:JORDHEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 VAIL CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5165
Mailing Address - Country:US
Mailing Address - Phone:701-330-7772
Mailing Address - Fax:
Practice Address - Street 1:37 VAIL CIR
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5165
Practice Address - Country:US
Practice Address - Phone:701-330-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15822235Z00000X
ND2620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND51030Medicaid