Provider Demographics
NPI:1962168609
Name:ROGERS, JENIFER
Entity type:Individual
Prefix:
First Name:JENIFER
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 1:111 KINGS WAY APT 91
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-2890
Mailing Address - Country:US
Mailing Address - Phone:830-488-4225
Mailing Address - Fax:
Practice Address - Street 1:111 KINGS WAY APT 91
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-2890
Practice Address - Country:US
Practice Address - Phone:830-488-5957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool