Healthcare Provider Details

I. General information

NPI: 1659983419
Provider Name (Legal Business Name): JORDYN ROGGENKAMP LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5147 44TH ST S # 5
FARGO ND
58104-6069
US

IV. Provider business mailing address

3680 42ND ST S APT 100
FARGO ND
58104-7443
US

V. Phone/Fax

Practice location:
  • Phone: 701-369-3181
  • Fax:
Mailing address:
  • Phone: 320-766-4329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1435-5-1-25-632
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number03468
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: