Healthcare Provider Details

I. General information

NPI: 1669903167
Provider Name (Legal Business Name): AIMEE ROGERS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2017
Last Update Date: 03/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ANGWIN AVE
ANGWIN CA
94508-9713
US

IV. Provider business mailing address

PO BOX 328
ANGWIN CA
94508-0328
US

V. Phone/Fax

Practice location:
  • Phone: 707-968-7565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: