Provider Demographics
NPI:1013569052
Name:ROGERS, JEANETTE (T-LMLP)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:T-LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-1420
Mailing Address - Country:US
Mailing Address - Phone:785-448-6806
Mailing Address - Fax:
Practice Address - Street 1:519 S ELM ST
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1420
Practice Address - Country:US
Practice Address - Phone:785-448-6806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2923103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist