Provider Demographics
NPI:1912170945
Name:ROGERS, JAMES GLENN (PSYSD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GLENN
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PSYSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 DANIELSON RD
Mailing Address - Street 2:SUMMIT PREPARATORY SCHOOL
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-7252
Mailing Address - Country:US
Mailing Address - Phone:406-758-8124
Mailing Address - Fax:
Practice Address - Street 1:1605 DANIELSON RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-7252
Practice Address - Country:US
Practice Address - Phone:406-758-8124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT326103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist