Provider Demographics
NPI:1396022117
Name:ROGERS, SHARRI PETERSON (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:SHARRI
Middle Name:PETERSON
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 SOUTH WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405
Mailing Address - Country:US
Mailing Address - Phone:612-377-9190
Mailing Address - Fax:612-374-4498
Practice Address - Street 1:2809 SOUTH WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405
Practice Address - Country:US
Practice Address - Phone:612-377-9190
Practice Address - Fax:612-374-4498
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1928106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist