Healthcare Provider Details

I. General information

NPI: 1760402432
Provider Name (Legal Business Name): DENNIS LINN ROGERS MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON BARRACKS RD
SAINT LOUIS MO
63125-4181
US

IV. Provider business mailing address

2414 OLD FREDERICKTOWN RD
FARMINGTON MO
63640-7510
US

V. Phone/Fax

Practice location:
  • Phone: 314-894-6538
  • Fax: 314-894-5783
Mailing address:
  • Phone: 573-756-3176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number001012
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: