Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2923 | KS |
Y | 103T00000X | Psychologist | 2923 | KS |
NPI | 1013569052 |
---|---|
Provider Name | Jeanette Rogers |
First Address | Garnett, KS 66032-1420 |
Second Address | Garnett, KS 66032-1420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2019 |
Last Update Date | 10/07/2019 |