Provider Demographics
NPI:1326580630
Name:ROGERS, LATISHA MICHELLE (MSW, LICSW, MHP)
Entity Type:Individual
Prefix:MS
First Name:LATISHA
Middle Name:MICHELLE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MSW, LICSW, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3832
Mailing Address - Country:US
Mailing Address - Phone:509-241-7315
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:3501 COLBY AVE STE 105
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4795
Practice Address - Country:US
Practice Address - Phone:425-273-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW600036481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical