Provider Demographics
NPI:1235479247
Name:ROGGE, DAVID FARRIS (MA, LADC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:FARRIS
Last Name:ROGGE
Suffix:
Gender:M
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2473 103RD LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4528
Mailing Address - Country:US
Mailing Address - Phone:763-323-6646
Mailing Address - Fax:
Practice Address - Street 1:2473 103RD LN NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4528
Practice Address - Country:US
Practice Address - Phone:763-323-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303099101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)