Provider Demographics
NPI:1033928932
Name:ROGERS, SAMANTHA FAYE (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:FAYE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:FAYE
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19250 STATE HIGHWAY 95
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-8420
Mailing Address - Country:US
Mailing Address - Phone:612-360-0887
Mailing Address - Fax:
Practice Address - Street 1:200 3RD AVE NE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1299
Practice Address - Country:US
Practice Address - Phone:320-629-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP7148103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical