Provider Demographics
NPI:1144229428
Name:ROGERS, KITTIE A (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KITTIE
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:504 N WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5654
Mailing Address - Country:US
Mailing Address - Phone:573-529-0732
Mailing Address - Fax:573-875-3183
Practice Address - Street 1:2100 E BROADWAY STE 217B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6082
Practice Address - Country:US
Practice Address - Phone:573-529-0732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002690101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO187340OtherBCBS
MO506201904OtherHCY MEDICAID NUMBER
MO497810218Medicaid
MO187340OtherANTHEM EAP