Healthcare Provider Details

I. General information

NPI: 1073006086
Provider Name (Legal Business Name): CARLYLE W ROGERS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2363 N HILL FIELD RD STE 113
LAYTON UT
84041-6958
US

IV. Provider business mailing address

2363 N HILL FIELD RD STE 113
LAYTON UT
84041-6958
US

V. Phone/Fax

Practice location:
  • Phone: 661-312-7737
  • Fax:
Mailing address:
  • Phone: 661-312-7737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: