Provider Demographics
NPI:1821660192
Name:GASSER, ROGER LEE
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:LEE
Last Name:GASSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15515 ROAD 111
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-9350
Mailing Address - Country:US
Mailing Address - Phone:567-808-8755
Mailing Address - Fax:
Practice Address - Street 1:15515 ROAD 111
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-9350
Practice Address - Country:US
Practice Address - Phone:567-808-8755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE00900126101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty