Healthcare Provider Details

I. General information

NPI: 1396459285
Provider Name (Legal Business Name): JENNIFER J ROGERS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 E 13 MILE RD STE 200
WARREN MI
48093-3093
US

IV. Provider business mailing address

57334 PLYMOUTH RD
WASHINGTON TOWNSHIP MI
48094-3355
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-1810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: