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General NPI Number Information
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NPI Number | 1871954362
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Entity Type | Individual
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Provider Name | JONATHAN MICHAEL ROGERS DE ALCERRO M.A.
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Gender | Male
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Dates
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Enumeration Date | 03/11/2016
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Last Update Date | 08/11/2019
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Provider Practice Location Address
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Address Line | 1522 E SUPERIOR ST
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City | DULUTH
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State | MN
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Zip | 55812-1634
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Country | US
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Telephone | 218-724-3122
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Fax |
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Provider Business Mailing Address
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Address Line | 1522 E SUPERIOR ST
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City | DULUTH
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State | MN
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Zip | 55812-1634
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Country | US
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Telephone | 218-724-3122
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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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