Provider Demographics
NPI:1144594417
Name:RODGER, YVETTE LESHAN
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:LESHAN
Last Name:RODGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 W IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-2810
Mailing Address - Country:US
Mailing Address - Phone:310-419-9616
Mailing Address - Fax:310-590-1357
Practice Address - Street 1:3211 W IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2810
Practice Address - Country:US
Practice Address - Phone:310-419-9616
Practice Address - Fax:310-590-1357
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARS6302101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor