Provider Demographics
NPI:1336387190
Name:RODGERS, STEPHANIE ANN
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:RODGERS
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 1:550 W RANCHO VISTA BLVD
Mailing Address - Street 2:STE D PMB 1053
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3011
Mailing Address - Country:US
Mailing Address - Phone:661-449-7181
Mailing Address - Fax:
Practice Address - Street 1:39915 CAPLAND DR
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-5275
Practice Address - Country:US
Practice Address - Phone:661-449-7181
Practice Address - Fax:661-424-7839
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT52615106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist