Healthcare Provider Details

I. General information

NPI: 1982000709
Provider Name (Legal Business Name): ROGER W OGREN MS, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 N 29TH ST
BILLINGS MT
59101-0122
US

IV. Provider business mailing address

PO BOX 353
ABSAROKEE MT
59001-0353
US

V. Phone/Fax

Practice location:
  • Phone: 406-869-6868
  • Fax: 406-294-0112
Mailing address:
  • Phone: 406-328-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAC-LAC-LIC-1237
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: