Provider Demographics
NPI:1336176460
Name:ROGERS, DIANNE M (PSYD, MSCP)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:M
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PSYD, MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24148 S 201ST PL
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5096
Mailing Address - Country:US
Mailing Address - Phone:480-688-8397
Mailing Address - Fax:
Practice Address - Street 1:24148 S 201ST PL
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5096
Practice Address - Country:US
Practice Address - Phone:480-688-8397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical