Provider Demographics
NPI:1760025076
Name:ROGERS, LORI (LPN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GNADENHUTTEN
Mailing Address - State:OH
Mailing Address - Zip Code:44629-9754
Mailing Address - Country:US
Mailing Address - Phone:330-407-2633
Mailing Address - Fax:
Practice Address - Street 1:328 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:GNADENHUTTEN
Practice Address - State:OH
Practice Address - Zip Code:44629-9754
Practice Address - Country:US
Practice Address - Phone:330-407-2633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities