Healthcare Provider Details

I. General information

NPI: 1316877202
Provider Name (Legal Business Name): JOAN ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4913 HELBUSH DR
LAKEPORT CA
95453-7060
US

IV. Provider business mailing address

PO BOX 2371
CLEARLAKE CA
95422-2301
US

V. Phone/Fax

Practice location:
  • Phone: 707-262-4253
  • Fax:
Mailing address:
  • Phone: 530-786-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW122687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: