Provider Demographics
NPI:1689227878
Name:ROGERS, HEIDI LYNN (LMSW, CADC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 PARKCENTRE WAY
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1792
Mailing Address - Country:US
Mailing Address - Phone:208-229-6050
Mailing Address - Fax:208-229-6052
Practice Address - Street 1:1407 W MCMILLAN RD STE 120
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5168
Practice Address - Country:US
Practice Address - Phone:208-315-6717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID428271041C0700X
ID11413101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical