Provider Demographics
NPI:1205409471
Name:RODGERS, JENNIFER RACHELLE (PSS, CRM,CADC-R)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RACHELLE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:PSS, CRM,CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-2756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 HITCHING POST RD
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-9710
Practice Address - Country:US
Practice Address - Phone:541-237-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information