Provider Demographics
NPI:1205057767
Name:RODGERS, KATHLEEN A (PC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:RODGERS
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 INDEPENDENCE LN
Mailing Address - Street 2:APARTMENT B8
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-8686
Mailing Address - Country:US
Mailing Address - Phone:724-285-4913
Mailing Address - Fax:
Practice Address - Street 1:112 HILLVUE DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-3426
Practice Address - Country:US
Practice Address - Phone:724-287-0791
Practice Address - Fax:724-287-2730
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004547101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional