Provider Demographics
NPI:1134395221
Name:ROGERS, GWENDOLYN ANNE (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:ANNE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ND, LAC
Mailing Address - Street 1:PO BOX 1716
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3401
Mailing Address - Country:US
Mailing Address - Phone:503-673-1630
Mailing Address - Fax:503-673-8051
Practice Address - Street 1:12570 SW 69TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2552
Practice Address - Country:US
Practice Address - Phone:503-673-1630
Practice Address - Fax:503-691-9018
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01269171100000X
OR1615175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist