Provider Demographics
NPI:1528035599
Name:ROGGENBACH, ROBERT DEFORREST (MSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DEFORREST
Last Name:ROGGENBACH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 E 40 HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5955
Mailing Address - Country:US
Mailing Address - Phone:816-350-3333
Mailing Address - Fax:816-478-8888
Practice Address - Street 1:12600 E 40 HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5955
Practice Address - Country:US
Practice Address - Phone:816-350-3333
Practice Address - Fax:816-478-8888
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW 0001771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical