Provider Demographics
NPI:1699106005
Name:ROGERS, ANNA LYN (BCBA, LMFTA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:LYN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:BCBA, LMFTA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:LYN
Other - Last Name:MCMURREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13765 VINTAGE DR SW
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-7391
Mailing Address - Country:US
Mailing Address - Phone:253-970-2414
Mailing Address - Fax:
Practice Address - Street 1:13765 VINTAGE DR SW
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-7391
Practice Address - Country:US
Practice Address - Phone:253-970-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA60927802103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst