| Daryn R. Rogers, Phd, Lp, Llc | |
|
15832 Venture Ln Eden Prairie MN 55344-5732 | |
| (952) 209-9200 | |
| (952) 209-9201 |
| Full Name | Daryn R. Rogers, Phd, Lp, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 15832 Venture Ln, Eden Prairie, Minnesota |
| Authorized Official Name and Position | Daryn R Rogers (PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 9522099200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Daryn R. Rogers, Phd, Lp, Llc 15832 Venture Ln Eden Prairie MN 55344-5732 Ph: (952) 209-9200 | Daryn R. Rogers, Phd, Lp, Llc 15832 Venture Ln Eden Prairie MN 55344-5732 Ph: (952) 209-9200 |
| NPI Number | 1316505803 |
|---|---|
| Provider Enumeration Date | 05/30/2019 |
| Last Update Date | 04/25/2022 |
| Certification Date | 04/25/2022 |
| Medicare PECOS PAC ID | 6709212236 |
|---|---|
| Medicare Enrollment ID | O20200131002594 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316505803 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Daryn R Rogers |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538310685 PECOS PAC ID: 8426484957 Enrollment ID: I20200131002638 |
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