Provider Demographics
NPI:1104982859
Name:ROGGEMAN, RANDI MICHELLE (LPC)
Entity type:Individual
Prefix:MS
First Name:RANDI
Middle Name:MICHELLE
Last Name:ROGGEMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:MICHELLE
Other - Last Name:HERMAN-ROGGEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MC
Mailing Address - Street 1:2500 S. POWER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209
Mailing Address - Country:US
Mailing Address - Phone:480-985-0333
Mailing Address - Fax:480-768-1564
Practice Address - Street 1:2500 S. POWER RD STE 108
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209
Practice Address - Country:US
Practice Address - Phone:480-985-0333
Practice Address - Fax:480-768-1564
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-2209101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health