Healthcare Provider Details

I. General information

NPI: 1538936679
Provider Name (Legal Business Name): MRS. SHERRI ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/08/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 W CAPITOL DR STE 304
MILWAUKEE WI
53216-2056
US

IV. Provider business mailing address

6115 N DENMARK ST
MILWAUKEE WI
53225-1672
US

V. Phone/Fax

Practice location:
  • Phone: 414-909-1079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: