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General NPI Number Information
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NPI Number | 1114316601
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Entity Type | Individual
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Provider Name | MIYA ROGERS LPC
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Gender | Female
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 1220 DEWEY AVE
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City | WAUWATOSA
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State | WI
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Zip | 53213-2504
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Country | US
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Telephone | 414-773-4312
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5044
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Country | US
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Telephone | 800-326-2250
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6964
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2267-226
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8133-125
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License Number State | WI
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