Provider Demographics
NPI:1467495275
Name:ROGERS, CORINNE ANN (PSYD,LP)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:ANN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PSYD,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 CADIEUX RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1511
Mailing Address - Country:US
Mailing Address - Phone:248-219-6627
Mailing Address - Fax:
Practice Address - Street 1:23650 WOODWARD AVE STE 109
Practice Address - Street 2:
Practice Address - City:PLEASANT RIDGE
Practice Address - State:MI
Practice Address - Zip Code:48069-1141
Practice Address - Country:US
Practice Address - Phone:248-219-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012708103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist