Healthcare Provider Details

I. General information

NPI: 1619705803
Provider Name (Legal Business Name): KRISTI ROGERS APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 S RIVERSIDE DR STE 102
BELOIT WI
53511-1500
US

IV. Provider business mailing address

N6528 ANDERSON DR
DELAVAN WI
53115-2694
US

V. Phone/Fax

Practice location:
  • Phone: 608-299-7669
  • Fax: 608-621-5180
Mailing address:
  • Phone: 262-566-8703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: