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General NPI Number Information
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NPI Number | 1174785034
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Entity Type | Organization
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Legal Business Name | RODGERS PSYCHOLOGICAL SERVICES, INC
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 1595 SELBY AVE SUITE 210
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City | SAINT PAUL
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State | MN
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Zip | 55104-6221
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Country | US
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Telephone | 651-644-4611
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Fax | 651-644-4618
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Provider Business Mailing Address
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Address Line | 1595 SELBY AVE SUITE 210
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City | SAINT PAUL
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State | MN
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Zip | 55104-6221
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Country | US
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Telephone | 651-644-4611
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Fax | 651-644-4618
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. RICHARD W RODGERS
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Credential | EDD, ABPP
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Telephone | 651-644-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP2265
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License Number State | MN
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