Provider Demographics
NPI:1770594350
Name:BISCHOFF, RODGER D (LPC)
Entity type:Individual
Prefix:MR
First Name:RODGER
Middle Name:D
Last Name:BISCHOFF
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E 8400 SO
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0525
Mailing Address - Country:US
Mailing Address - Phone:801-566-2556
Mailing Address - Fax:801-566-2639
Practice Address - Street 1:625 E 8400 SO
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0525
Practice Address - Country:US
Practice Address - Phone:801-566-2556
Practice Address - Fax:801-566-2639
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1214516004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional