Provider Demographics
NPI:1316444391
Name:ROGERS, JENNA (LMFT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10653 WILDROSE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6394
Mailing Address - Country:US
Mailing Address - Phone:951-233-2145
Mailing Address - Fax:
Practice Address - Street 1:10653 WILDROSE DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6394
Practice Address - Country:US
Practice Address - Phone:951-233-2145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111940106H00000X
CA149671106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist