Healthcare Provider Details

I. General information

NPI: 1801700380
Provider Name (Legal Business Name): JILL ELIZABETH ROGSTAD PH.D., ABPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL ELIZABETH ROGSTAD BRUVOLD

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CENTER ST NE
SALEM OR
97301-2682
US

IV. Provider business mailing address

PO BOX 44176
EDEN PRAIRIE MN
55344-1176
US

V. Phone/Fax

Practice location:
  • Phone: 612-246-4945
  • Fax: 612-246-4945
Mailing address:
  • Phone: 612-246-4945
  • Fax: 612-246-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: