Provider Demographics
NPI:1649523127
Name:ROGERS, RANDALL JOEL (MS)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:JOEL
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31182
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-0182
Mailing Address - Country:US
Mailing Address - Phone:402-573-1142
Mailing Address - Fax:
Practice Address - Street 1:6124 N 99TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1548
Practice Address - Country:US
Practice Address - Phone:402-884-0716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-20
Last Update Date:2012-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health