Provider Demographics
NPI:1215576327
Name:ROGERS, KATHRYN GAYLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:GAYLE
Last Name: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 1:9668 SW CHESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2515
Mailing Address - Country:US
Mailing Address - Phone:678-521-8448
Mailing Address - Fax:
Practice Address - Street 1:9668 SW CHESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2515
Practice Address - Country:US
Practice Address - Phone:678-521-8448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health