Provider Demographics
NPI:1417506247
Name:ROGERS, VICKIE LYNN
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:LYNN
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 1:15327 WOODRUFF PL APT 229
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-4052
Mailing Address - Country:US
Mailing Address - Phone:562-608-5505
Mailing Address - Fax:
Practice Address - Street 1:15405 LANSDOWNE RD STE C
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-0201
Practice Address - Country:US
Practice Address - Phone:714-258-7710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor