Provider Demographics
NPI:1467743492
Name:ROGERS, KENTREISHA RAYE
Entity Type:Individual
Prefix:MRS
First Name:KENTREISHA
Middle Name:RAYE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 WILLOW TREE DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3368
Mailing Address - Country:US
Mailing Address - Phone:702-806-2418
Mailing Address - Fax:
Practice Address - Street 1:4085 N RANCHO DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3466
Practice Address - Country:US
Practice Address - Phone:702-349-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor