Provider Demographics
NPI:1124775127
Name:RODGERS, JOANNA LAUREL
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:LAUREL
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 1:4275 COMMERCIAL ST SE STE 180
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4087
Mailing Address - Country:US
Mailing Address - Phone:503-363-8068
Mailing Address - Fax:
Practice Address - Street 1:72A CENTENNIAL LOOP STE 150
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2447
Practice Address - Country:US
Practice Address - Phone:971-707-1479
Practice Address - Fax:541-349-9226
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker