Provider Demographics
NPI:1902876188
Name:ROGERS, PATRICIA J (LICSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3548 BRYANT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4119
Mailing Address - Country:US
Mailing Address - Phone:612-822-8227
Mailing Address - Fax:612-825-4204
Practice Address - Street 1:1385 MENDOTA HEIGHTS RD STE 200
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1289
Practice Address - Country:US
Practice Address - Phone:651-379-9800
Practice Address - Fax:651-405-0358
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN050281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN151358300Medicaid