Provider Demographics
NPI:1942598610
Name:ROGENE, NANCY NATALIA (PHD LMFT)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:NATALIA
Last Name:ROGENE
Suffix:
Gender:F
Credentials:PHD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30250 SW PARKWAY AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9757
Mailing Address - Country:US
Mailing Address - Phone:503-682-0957
Mailing Address - Fax:
Practice Address - Street 1:30250 SW PARKWAY AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9757
Practice Address - Country:US
Practice Address - Phone:503-682-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0809101YP2500X
ORT0236106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional