Provider Demographics
NPI:1760540207
Name:ROGERS, J'DENE MICHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:J'DENE
Middle Name:MICHELLE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-2758
Mailing Address - Country:US
Mailing Address - Phone:918-682-9292
Mailing Address - Fax:918-682-9254
Practice Address - Street 1:2024 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2758
Practice Address - Country:US
Practice Address - Phone:918-682-9292
Practice Address - Fax:918-682-9254
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK915103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist