Provider Demographics
NPI:1932295383
Name:EHLERT, ROGER CLAUS (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CLAUS
Last Name:EHLERT
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 1:424 E SHERMAN AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-1701
Mailing Address - Country:US
Mailing Address - Phone:208-667-0544
Mailing Address - Fax:208-667-0544
Practice Address - Street 1:424 E SHERMAN AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-1701
Practice Address - Country:US
Practice Address - Phone:208-667-0544
Practice Address - Fax:208-667-0544
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000622103T00000X
IDPSY56103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDN0567OtherBLUE CROSS OF IDAHO
ID000010015973OtherREGENCE BLUE SHIELD OF ID
IDN4700OtherBLUE CROSS OF IDAHO
1680076Medicare ID - Type Unspecified