Provider Demographics
NPI:1639393614
Name:LAUER, ROGER E (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:E
Last Name:LAUER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5864 INTERFACE DR STE D
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9514
Mailing Address - Country:US
Mailing Address - Phone:734-994-9466
Mailing Address - Fax:734-994-9465
Practice Address - Street 1:5864 INTERFACE DR STE D
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9514
Practice Address - Country:US
Practice Address - Phone:734-994-9466
Practice Address - Fax:734-994-9465
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007927103TM1800X, 103TP2701X, 103TC0700X, 103TC2200X, 103TF0000X, 103TF0200X, 103G00000X, 103T00000X, 103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680H112930OtherBLUE CROSS BLUE SHIELD