Provider Demographics
NPI:1992366652
Name:ROGERS, VIOLA KAYE (CADCI/CRM/PWS/QMHA-I)
Entity Type:Individual
Prefix:
First Name:VIOLA
Middle Name:KAYE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CADCI/CRM/PWS/QMHA-I
Other - Prefix:
Other - First Name:KAYE
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADCI/CRM/PWS/QMHA-I
Mailing Address - Street 1:1776 SW MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1715
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:503-621-2235
Practice Address - Street 1:1438 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1140
Practice Address - Country:US
Practice Address - Phone:503-548-0346
Practice Address - Fax:503-232-5959
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-CRM-2480101YA0400X
OR21-QMHA-I-003245101YM0800X
ORTHW000106357175T00000X
OR19-05-12101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500804633Medicaid
OR500784224Medicaid
OR500764863Medicaid