Provider Demographics
NPI:1972773406
Name:ROGERS, MARIANN (LSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIANN
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MRS
Other - First Name:MARIANN
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:305 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1578
Mailing Address - Country:US
Mailing Address - Phone:740-532-4858
Mailing Address - Fax:740-532-4859
Practice Address - Street 1:120 N 3RD ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1574
Practice Address - Country:US
Practice Address - Phone:740-532-7855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-0025607101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0262953Medicaid