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NPI Code Detail

MEDICARE: JAIDELYNN ROGERS PHD

MEDICARE: JAIDELYNN ROGERS PHD
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
1103TC1900XCounseling Psychologist
2103T00000XPsychologist

General Provider Information

NPI Number : 1336924414
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAIDELYNN ROGERS PHD
Provider Business Mailing Address
First Line : 1001 W STONEHAVEN DR
Second Line :
City : NORTH SALT LAKE
State : UT
Zip : 84054-5032
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 331 S 600 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-4013
Country : US
Telephone Number : 801-613-7305
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2023
Last Update Date : 08/28/2023

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