Provider Demographics
NPI:1881142537
Name:ROGERS, MICHELLE LYNN (MSSA, LSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MSSA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:OH
Mailing Address - Zip Code:45321-5064
Mailing Address - Country:US
Mailing Address - Phone:937-733-0496
Mailing Address - Fax:
Practice Address - Street 1:211 E MILL ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:OH
Practice Address - Zip Code:45321-5064
Practice Address - Country:US
Practice Address - Phone:937-733-0496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1201211101Y00000X, 101YA0400X, 1041C0700X, 101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health