Healthcare Provider Details

I. General information

NPI: 1841515186
Provider Name (Legal Business Name): LESLIE JEAN ROGERS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N MORRISON BLVD STE G
HAMMOND LA
70401-2312
US

IV. Provider business mailing address

620 N MORRISON BLVD STE G
HAMMOND LA
70401-2312
US

V. Phone/Fax

Practice location:
  • Phone: 985-543-4113
  • Fax: 985-543-4109
Mailing address:
  • Phone: 985-543-4113
  • Fax: 985-543-4109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1120
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1120
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1120
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1120
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1120
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1120
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: