Healthcare Provider Details

I. General information

NPI: 1528998747
Provider Name (Legal Business Name): STEPHANIE ROGGE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E19320 BARTIG RD
AUGUSTA WI
54722-7501
US

IV. Provider business mailing address

E19320 BARTIG RD
AUGUSTA WI
54722-7501
US

V. Phone/Fax

Practice location:
  • Phone: 715-286-2291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: