Healthcare Provider Details

I. General information

NPI: 1649237744
Provider Name (Legal Business Name): GEORGE W ROGERS JR. ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E PIKE ST
COVINGTON KY
41011-2442
US

IV. Provider business mailing address

502 FARRELL DR
COVINGTON KY
41011-3717
US

V. Phone/Fax

Practice location:
  • Phone: 859-491-1348
  • Fax: 859-491-7174
Mailing address:
  • Phone: 859-331-3292
  • Fax: 859-578-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0238
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: