Healthcare Provider Details

I. General information

NPI: 1538068630
Provider Name (Legal Business Name): CALLIE ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2026
Last Update Date: 11/04/2026
Certification Date: 11/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 MAPLEWOOD DR N STE 312
MAPLEWOOD MN
55109-1985
US

IV. Provider business mailing address

535 SANDHURST DR W APT 310
SAINT PAUL MN
55113-4669
US

V. Phone/Fax

Practice location:
  • Phone: 651-760-3109
  • Fax:
Mailing address:
  • Phone: 701-430-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: