Provider Demographics
NPI:1174785034
Name:RODGERS PSYCHOLOGICAL SERVICES, INC
Entity type:Organization
Organization Name:RODGERS PSYCHOLOGICAL SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, ABPP
Authorized Official - Phone:651-644-4611
Mailing Address - Street 1:1595 SELBY AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6221
Mailing Address - Country:US
Mailing Address - Phone:651-644-4611
Mailing Address - Fax:651-644-4618
Practice Address - Street 1:1595 SELBY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6221
Practice Address - Country:US
Practice Address - Phone:651-644-4611
Practice Address - Fax:651-644-4618
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RODGERS PSYCHOLOGICAL SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2265103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty