Provider Demographics
NPI:1750490967
Name:ROGERS, LINDA SUE
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUE
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 1:401 S 23RD ST APT D
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3750
Mailing Address - Country:US
Mailing Address - Phone:580-323-2507
Mailing Address - Fax:
Practice Address - Street 1:408 S 17TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-4236
Practice Address - Country:US
Practice Address - Phone:580-323-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health