MEDICARE: TERESA 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	101YP2500X	Professional Counselor	E.1000181	OH
2	106H00000X	Marriage & Family Therapist	F.1400020	OH

General Provider Information

NPI Number	:	1942699202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ROGERS

Provider Business Mailing Address
First Line	:	7023A MEARS GATE DR NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-8849
Country	:	US
Telephone Number	:	330-497-2452
Fax Number	:	330-497-2749

Provider Business Practice Location Address
First Line	:	7023A MEARS GATE DR NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-8849
Country	:	US
Telephone Number	:	330-497-2452
Fax Number	:	330-497-2749

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

Provider Enumeration Date	:	01/09/2015
Last Update Date	:	01/09/2015

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Directions to “ TERESA ROGERS ” Practice Location

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