Healthcare Provider Details

I. General information

NPI: 1093442063
Provider Name (Legal Business Name): JODELL WILSON ROGERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JO DELL WILSON ROGERS LCSW

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E OLIVE ST
LAMAR CO
81052-2841
US

IV. Provider business mailing address

301 E OLIVE ST
LAMAR CO
81052-2840
US

V. Phone/Fax

Practice location:
  • Phone: 719-931-9844
  • Fax: 719-931-8007
Mailing address:
  • Phone: 719-931-9844
  • Fax: 719-931-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09932396
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCSW.09932396
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: