Provider Demographics
NPI:1417280629
Name:ROGERS, JEFFREY L (JD, MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:L
Last Name:ROGERS
Suffix:
Gender:M
Credentials:JD, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 SW KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4630
Mailing Address - Country:US
Mailing Address - Phone:503-806-3344
Mailing Address - Fax:503-768-4411
Practice Address - Street 1:3434 SW KELLY AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4630
Practice Address - Country:US
Practice Address - Phone:503-806-3344
Practice Address - Fax:503-768-4411
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2346101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health