Provider Demographics
NPI:1306946959
Name:ROGERS, NELLIE B (LISW)
Entity type:Individual
Prefix:MRS
First Name:NELLIE
Middle Name:B
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:NELLIE
Other - Middle Name:B
Other - Last Name:PRYOR-ROGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:1034 N PORTAGE PATH
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5828
Mailing Address - Country:US
Mailing Address - Phone:330-592-5744
Mailing Address - Fax:
Practice Address - Street 1:55 W WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1116
Practice Address - Country:US
Practice Address - Phone:330-724-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00088471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical