1033928932 NPI number — DR. SAMANTHA FAYE ROGERS PSY.D, LP

Table of content: DR. SAMANTHA FAYE ROGERS PSY.D, LP (NPI 1033928932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033928932 NPI number — DR. SAMANTHA FAYE ROGERS PSY.D, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
SAMANTHA
Provider Middle Name:
FAYE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D, LP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POPE
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
FAYE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033928932
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19250 STATE HIGHWAY 95
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55371-8420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-360-0887
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 3RD AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55008-1299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-629-7600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  LP7148 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)