Provider Demographics
NPI:1073006086
Name:ROGERS, CARLYLE W (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARLYLE
Middle Name:W
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2363 N HILL FIELD RD STE 113
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-6958
Mailing Address - Country:US
Mailing Address - Phone:661-312-7737
Mailing Address - Fax:
Practice Address - Street 1:2363 N HILL FIELD RD STE 113
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-6958
Practice Address - Country:US
Practice Address - Phone:661-312-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health