Provider Demographics
NPI:1710005442
Name:RODGERSON, MICHAEL JOE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOE
Last Name:RODGERSON
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 1:10610 CARENA CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-6818
Mailing Address - Country:US
Mailing Address - Phone:402-440-9941
Mailing Address - Fax:
Practice Address - Street 1:7441 O ST
Practice Address - Street 2:SUITE 402
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2466
Practice Address - Country:US
Practice Address - Phone:402-483-4215
Practice Address - Fax:402-483-5228
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE88103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE264033Medicare ID - Type Unspecified