Provider Demographics
NPI:1457563561
Name:ROGERS, THERESA MARIE (MSW,)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:MARIE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 BIGELOW AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2622
Mailing Address - Country:US
Mailing Address - Phone:206-548-1223
Mailing Address - Fax:206-632-4467
Practice Address - Street 1:3876 BRIDGE WAY N
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7951
Practice Address - Country:US
Practice Address - Phone:206-548-1223
Practice Address - Fax:206-632-4467
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000041101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical