Provider Demographics
NPI:1568817971
Name:ROGSTAD, RICK (BC-HIS)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:ROGSTAD
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1964 CONCORD TRL
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-1442
Mailing Address - Country:US
Mailing Address - Phone:715-271-6390
Mailing Address - Fax:
Practice Address - Street 1:1964 CONCORD TRL
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-1442
Practice Address - Country:US
Practice Address - Phone:715-271-6390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1365237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist