Provider Demographics
NPI:1407248412
Name:ROGERS, SABRINA
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:ROGERS
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 1:400 E HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-1745
Mailing Address - Country:US
Mailing Address - Phone:920-723-0112
Mailing Address - Fax:
Practice Address - Street 1:301 HWY 1 SE STE B
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314
Practice Address - Country:US
Practice Address - Phone:920-723-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074905101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health