Provider Demographics
NPI:1528392172
Name:ROGERS, WENDY G
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:G
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 1:2201 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-6302
Mailing Address - Country:US
Mailing Address - Phone:850-656-2437
Mailing Address - Fax:850-942-6402
Practice Address - Street 1:2201 S MONROE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-6302
Practice Address - Country:US
Practice Address - Phone:850-656-2437
Practice Address - Fax:850-942-6402
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000611100Medicaid