Provider Demographics
NPI:1215669247
Name:ROGERS, EDWARD DALE JR
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:DALE
Last Name:ROGERS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 VICKI LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4558
Mailing Address - Country:US
Mailing Address - Phone:402-370-3140
Mailing Address - Fax:402-370-3373
Practice Address - Street 1:1900 VICKI LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4558
Practice Address - Country:US
Practice Address - Phone:402-370-3140
Practice Address - Fax:402-370-3373
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1985101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)