Provider Demographics
NPI:1114805868
Name:RODGERS, JACQUELYNNE (MA BCABA)
Entity type:Individual
Prefix:
First Name:JACQUELYNNE
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MA BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 W EAGLE CREST PL
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-8523
Mailing Address - Country:US
Mailing Address - Phone:570-691-6967
Mailing Address - Fax:
Practice Address - Street 1:2818 N RALPH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1635
Practice Address - Country:US
Practice Address - Phone:520-484-4674
Practice Address - Fax:520-300-8082
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst