Provider Demographics
NPI:1245369164
Name:ASIJA, ROGER K (MSINMFT, CSAC)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:K
Last Name:ASIJA
Suffix:
Gender:M
Credentials:MSINMFT, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 S 38TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2005
Mailing Address - Country:US
Mailing Address - Phone:414-447-9890
Mailing Address - Fax:414-447-9891
Practice Address - Street 1:6040 W LISBON AVE STE 200
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2116
Practice Address - Country:US
Practice Address - Phone:414-447-9890
Practice Address - Fax:414-447-9891
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14969-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43702100Medicaid