Provider Demographics
NPI:1841212727
Name:KENNETH C. RODGERS, PH.D., P.C.
Entity Type:Organization
Organization Name:KENNETH C. RODGERS, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-943-3319
Mailing Address - Street 1:8160 HIGHLAND DR
Mailing Address - Street 2:# 102
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6492
Mailing Address - Country:US
Mailing Address - Phone:801-943-3319
Mailing Address - Fax:
Practice Address - Street 1:8160 HIGHLAND DR
Practice Address - Street 2:# 102
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6492
Practice Address - Country:US
Practice Address - Phone:801-943-3319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1114662501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529563429016Medicaid