Provider Demographics
NPI:1588743942
Name:ROGGENKAMP, WILLIAM KIRK (LCSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:KIRK
Last Name:ROGGENKAMP
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 CRANDALL STATION RD NE
Mailing Address - Street 2:
Mailing Address - City:CRANDALL
Mailing Address - State:IN
Mailing Address - Zip Code:47114-9458
Mailing Address - Country:US
Mailing Address - Phone:502-718-1911
Mailing Address - Fax:
Practice Address - Street 1:1556 N OLD HIGHWAY 135
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2002
Practice Address - Country:US
Practice Address - Phone:812-738-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004408A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health