Provider Demographics
NPI:1639158413
Name:ROGERS, JANEL A (PSYD)
Entity Type:Individual
Prefix:
First Name:JANEL
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4749
Mailing Address - Country:US
Mailing Address - Phone:260-373-8000
Mailing Address - Fax:260-373-8034
Practice Address - Street 1:1720 BEACON ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4749
Practice Address - Country:US
Practice Address - Phone:260-373-8000
Practice Address - Fax:260-373-8034
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040322A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000203700OtherANTHEM
INP00293052OtherRAILROAD MEDICARE
IN000000543925OtherANTHEM
IN100384920Medicaid
INP00478525OtherRAILROAD MEDICARE
IN1771OtherPHYSICIANS HEALTH PLAN
IN1771OtherPHYSICIANS HEALTH PLAN
IN668340AMedicare PIN