Provider Demographics
NPI:1538310685
Name:ROGERS, DARYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DARYN
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:DARYN
Other - Middle Name:
Other - Last Name:RAHARDJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15832 VENTURE LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5732
Mailing Address - Country:US
Mailing Address - Phone:952-209-9200
Mailing Address - Fax:952-209-9201
Practice Address - Street 1:15832 VENTURE LN
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5732
Practice Address - Country:US
Practice Address - Phone:952-209-9200
Practice Address - Fax:952-209-9201
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6142103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling