Provider Demographics
NPI:1184259533
Name:ROGERS, WANDA JUDGE
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:JUDGE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-0905
Mailing Address - Country:US
Mailing Address - Phone:919-353-7900
Mailing Address - Fax:
Practice Address - Street 1:100 PERSON CT
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5857
Practice Address - Country:US
Practice Address - Phone:336-583-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician