Provider Demographics
NPI:1568030062
Name:ROGNLIEN, ANDREA (LPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ROGNLIEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4610 AMBER VALLEY PKWY S STE F
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8621
Mailing Address - Country:US
Mailing Address - Phone:701-551-1840
Mailing Address - Fax:701-551-1859
Practice Address - Street 1:4610 AMBER VALLEY PKWY S STE F
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8621
Practice Address - Country:US
Practice Address - Phone:701-551-1840
Practice Address - Fax:701-551-1859
Is Sole Proprietor?:No
Enumeration Date:2021-06-12
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND988-2-1-19101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional