Provider Demographics
NPI:1275587891
Name:LUDWIG, ROGER ALAN (MA)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:ALAN
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 DUNN AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3214
Mailing Address - Country:US
Mailing Address - Phone:307-637-5004
Mailing Address - Fax:307-637-5011
Practice Address - Street 1:2315 DUNN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001
Practice Address - Country:US
Practice Address - Phone:307-637-5004
Practice Address - Fax:307-637-5011
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC416101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor