Provider Demographics
NPI:1194827402
Name:BADER-ROGERS, JOYCE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:ANN
Last Name:BADER-ROGERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 SPRING VALLEY RD
Mailing Address - Street 2:SUITE 511
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3678
Mailing Address - Country:US
Mailing Address - Phone:972-467-7605
Mailing Address - Fax:972-241-0350
Practice Address - Street 1:4100 SPRING VALLEY RD
Practice Address - Street 2:SUITE 511
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3678
Practice Address - Country:US
Practice Address - Phone:972-467-7605
Practice Address - Fax:972-241-0350
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22359103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612272Medicare ID - Type Unspecified