Provider Demographics
NPI:1689864886
Name:ROGERS, REBECCA SUZANNE (MED MSW LSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUZANNE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MED MSW LSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:SUZANNE
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2965 S JONES BLVD
Mailing Address - Street 2:SUITE E-1 MAPLE STAR
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146
Mailing Address - Country:US
Mailing Address - Phone:702-733-8098
Mailing Address - Fax:702-395-6457
Practice Address - Street 1:2965 S JONES BLVD
Practice Address - Street 2:SUITE E-1 MAPLE STAR
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-733-8098
Practice Address - Fax:702-395-6457
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor