Provider Demographics
NPI:1215241203
Name:ROGERS, JENNIFER DENISE (PSYD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DENISE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11845 S 700 E STE 104
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9836
Mailing Address - Country:US
Mailing Address - Phone:801-332-9370
Mailing Address - Fax:
Practice Address - Street 1:11845 S 700 E STE 104
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9836
Practice Address - Country:US
Practice Address - Phone:801-332-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9152654-2501103TC0700X
UT91526542504103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical