MEDICARE: JOHN ROGERS MA L.P.C.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	01361	MN
2	101YM0800X	Mental Health Counselor	00945	MN

General Provider Information

NPI Number	:	1043526635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ROGERS MA L.P.C.C.

Provider Business Mailing Address
First Line	:	310 SW INDUSTRIAL WAY UNIT 290
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-3994
Country	:	US
Telephone Number	:	651-500-6827
Fax Number	:

Provider Business Practice Location Address
First Line	:	3747 MINNEHAHA AVE STE 206
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2858
Country	:	US
Telephone Number	:	651-500-6827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2010
Last Update Date	:	06/10/2026

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