Provider Demographics
NPI:1811676208
Name:ROGERS, TANSLEY LOVE (HIGH SCHOOL DIPLOMA)
Entity type:Individual
Prefix:
First Name:TANSLEY
Middle Name:LOVE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:HIGH SCHOOL DIPLOMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 BURLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-6200
Mailing Address - Country:US
Mailing Address - Phone:989-941-8328
Mailing Address - Fax:
Practice Address - Street 1:6296 BRIDGEPORT VILLAGE SQUARE DR STE 2
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9655
Practice Address - Country:US
Practice Address - Phone:989-401-1239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician