Provider Demographics
NPI:1265783351
Name:KIMBERLY J. ROGERS, PSY.D, LLC
Entity type:Organization
Organization Name:KIMBERLY J. ROGERS, PSY.D, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:334-699-3320
Mailing Address - Street 1:1369 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1309
Mailing Address - Country:US
Mailing Address - Phone:334-699-3320
Mailing Address - Fax:334-699-3342
Practice Address - Street 1:1369 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1309
Practice Address - Country:US
Practice Address - Phone:334-699-3320
Practice Address - Fax:334-699-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1587103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty