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Individual

MIYA ROGERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 773-4312
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
101YM0800X
Mental Health Counselor
Primary
8133-125
WI
101YP2500X
Professional Counselor
2267-226
WI
101YP2500X
Professional Counselor
6964
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100042604
WI
01
3335
MEDICARE
05
421504
SC
Enumeration date
01/21/2015
Last updated
02/13/2025
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