Provider Demographics
NPI:1699213231
Name:ROGERS, JOLENE DENEE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:DENEE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13620 OLD GLENN HWY
Mailing Address - Street 2:STE C
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577
Mailing Address - Country:US
Mailing Address - Phone:509-675-6888
Mailing Address - Fax:
Practice Address - Street 1:13620 OLD GLENN HWY
Practice Address - Street 2:STE C
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577
Practice Address - Country:US
Practice Address - Phone:509-675-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor