Provider Demographics
NPI:1306210547
Name:ROGERS, ANISSA (PHD, MSW, MA, LCSW)
Entity Type:Individual
Prefix:
First Name:ANISSA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHD, MSW, MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 NW 185TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-3492
Mailing Address - Country:US
Mailing Address - Phone:971-470-9067
Mailing Address - Fax:
Practice Address - Street 1:3220 NW 185TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-3492
Practice Address - Country:US
Practice Address - Phone:971-470-9067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-28
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL31771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical