Provider Demographics
NPI:1316326036
Name:ROGGENDORF, SUSAN (QMHP, LMHC, LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ROGGENDORF
Suffix:
Gender:
Credentials:QMHP, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 CHATEAU KNLS
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3417
Mailing Address - Country:US
Mailing Address - Phone:632-102-3595
Mailing Address - Fax:
Practice Address - Street 1:2435 KIMBERLY RD STE 270
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3509
Practice Address - Country:US
Practice Address - Phone:563-219-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.010927101YP2500X
IA072145101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional