MEDICARE: DOROTHY ELIZABETH ROGERS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	656LCSW	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	71125	OTHER	MT	BCBS MT

General Provider Information

NPI Number	:	1134168818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY ELIZABETH ROGERS LCSW

Provider Business Mailing Address
First Line	:	2525 S 3RD ST W
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-1328
Country	:	US
Telephone Number	:	406-396-3500
Fax Number	:	406-258-0634

Provider Business Practice Location Address
First Line	:	2525 S 3RD ST W
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-1328
Country	:	US
Telephone Number	:	406-396-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/31/2015

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