Individual
CAROL ROGERS-TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS LP
Contact information
Practice address
2399 ARIEL ST N STE D, MAPLEWOOD, MN 55109-2202
(651) 770-1311
(651) 770-1879
Mailing address
2399 ARIEL ST N STE D, MAPLEWOOD, MN 55109-2202
(651) 770-1311
(651) 770-1879
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP2901
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
857051500
—
MN
Enumeration date
05/11/2006
Last updated
06/24/2015
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