Provider Demographics
NPI:1871954362
Name:ROGERS DE ALCERRO, JONATHAN MICHAEL (MA)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:ROGERS DE ALCERRO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:JONATHAN
Other - Middle Name:MICHAEL
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1522 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1634
Mailing Address - Country:US
Mailing Address - Phone:218-724-3122
Mailing Address - Fax:
Practice Address - Street 1:1522 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1634
Practice Address - Country:US
Practice Address - Phone:218-724-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor