Provider Demographics
NPI:1922024074
Name:ROGERS, JOSEPH R
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2460
Mailing Address - Country:US
Mailing Address - Phone:614-299-6600
Mailing Address - Fax:614-421-3111
Practice Address - Street 1:6435 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1507
Practice Address - Country:US
Practice Address - Phone:614-856-9610
Practice Address - Fax:614-861-5411
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0005568101YM0800X
OHI.00055681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0274411Medicaid
OH0274411Medicaid