Provider Demographics
NPI:1073126397
Name:ROGERS, JENNIFER DANIELLE (LCPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DANIELLE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7237 W POTOMAC DR STE 210
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9146
Mailing Address - Country:US
Mailing Address - Phone:208-740-1284
Mailing Address - Fax:
Practice Address - Street 1:7237 W POTOMAC DR STE 210
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9146
Practice Address - Country:US
Practice Address - Phone:208-740-1284
Practice Address - Fax:208-906-0815
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-9126101YP2500X, 101YM0800X, 101YP2500X
IDLPC-7792101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1073126397Medicaid