Basic Information
Provider Information
NPI: 1003142209
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROGNESS
FirstName: PATRICIA
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1111 UNIVERSITY AVE
Address2:  
City: DES MOINES
State: IA
PostalCode: 503142329
CountryCode: US
TelephoneNumber: 5156977978
FaxNumber: 5152889109
Practice Location
Address1: 1111 UNIVERSITY AVE
Address2:  
City: DES MOINES
State: IA
PostalCode: 503142329
CountryCode: US
TelephoneNumber: 5156977978
FaxNumber: 5152889109
Other Information
ProviderEnumerationDate: 10/22/2009
LastUpdateDate: 10/22/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X001168IAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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