Healthcare Provider Details

I. General information

NPI: 1326555863
Provider Name (Legal Business Name): RICHARD ROGICH APSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 N PELHAM ST
RHINELANDER WI
54501-3148
US

IV. Provider business mailing address

22 N PELHAM ST
RHINELANDER WI
54501-3148
US

V. Phone/Fax

Practice location:
  • Phone: 715-365-6696
  • Fax: 715-365-6768
Mailing address:
  • Phone: 715-365-6696
  • Fax: 715-365-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number130801
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: