Provider Demographics
NPI:1063172203
Name:ROGERS, YOLONDA YVETTE (LICSW)
Entity type:Individual
Prefix:
First Name:YOLONDA
Middle Name:YVETTE
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 1:11500 WAYZATA BLVD # 1044
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2007
Mailing Address - Country:US
Mailing Address - Phone:612-354-6535
Mailing Address - Fax:
Practice Address - Street 1:2415 UPLAND LN N UNIT A
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1974
Practice Address - Country:US
Practice Address - Phone:612-385-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN240041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical