Provider Demographics
NPI:1598982258
Name:RODGERS PSYCHOLOGICAL SERVICES, INC
Entity Type:Organization
Organization Name:RODGERS PSYCHOLOGICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,LP
Authorized Official - Phone:651-229-6962
Mailing Address - Street 1:1772 JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2115
Mailing Address - Country:US
Mailing Address - Phone:651-229-6962
Mailing Address - Fax:651-227-8106
Practice Address - Street 1:333 GRAND AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2582
Practice Address - Country:US
Practice Address - Phone:651-229-6962
Practice Address - Fax:651-227-8106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty