Provider Demographics
NPI:1942223714
Name:ROGERS, MARCIA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:M
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7382 KIRKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5270
Mailing Address - Country:US
Mailing Address - Phone:763-424-3704
Mailing Address - Fax:763-424-8315
Practice Address - Street 1:7382 KIRKWOOD CT
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5270
Practice Address - Country:US
Practice Address - Phone:763-424-3704
Practice Address - Fax:763-424-8315
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP33691103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN126912OtherUBH
FM360G0M1OtherBLUE CROSS