Provider Demographics
NPI:1992366652
Name:ROGERS, VIOLA KAYE (CADCI/CRM/PWS/QMHA-I)
Entity type:Individual
Prefix:
First Name:VIOLA
Middle Name:KAYE
Last Name:ROGERS
Suffix:
Gender:
Credentials:CADCI/CRM/PWS/QMHA-I
Other - Prefix:
Other - First Name:KAYE
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADCI/CRM/PWS/QMHA-I
Mailing Address - Street 1:211 SE CARUTHERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4502
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:971-260-0355
Practice Address - Street 1:703 NE HANCOCK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3955
Practice Address - Country:US
Practice Address - Phone:503-230-9875
Practice Address - Fax:503-331-3441
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-CRM-2480101YA0400X
OR19-05-12101YA0400X
ORTHW000106357175T00000X
OR21-QMHA-I-003245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500764863Medicaid
OR500784224Medicaid
OR500804633Medicaid