Provider Demographics
NPI:1285824458
Name:ROGERS, WILLIAM MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
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 1:7406 27TH ST W STE 210
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4637
Mailing Address - Country:US
Mailing Address - Phone:253-444-8990
Mailing Address - Fax:253-442-6117
Practice Address - Street 1:7406 27TH ST W STE 210
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4637
Practice Address - Country:US
Practice Address - Phone:253-444-8990
Practice Address - Fax:253-442-6117
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003741103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1801049176Medicare UPIN
WA1285824458Medicare UPIN