MEDICARE: JARAKA NICOLE ROGERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033943915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARAKA NICOLE ROGERS

Provider Business Mailing Address
First Line	:	6001 WOODLAND AVE STE 2260
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-2769
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6001 WOODLAND AVE STE 2260
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-2769
Country	:	US
Telephone Number	:	216-831-2255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2024
Last Update Date	:	08/31/2024

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Directions to “ JARAKA NICOLE ROGERS ” Practice Location

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