Healthcare Provider Details

I. General information

NPI: 1144229428
Provider Name (Legal Business Name): KITTIE A ROGERS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN A ROGERS MSW, LCSW

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 10/25/2020
Certification Date: 10/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 E BROADWAY STE 217B
COLUMBIA MO
65201-6082
US

IV. Provider business mailing address

504 N WILLIAM ST
COLUMBIA MO
65201-5654
US

V. Phone/Fax

Practice location:
  • Phone: 573-529-0732
  • Fax:
Mailing address:
  • Phone: 573-529-0732
  • Fax: 573-875-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number002690
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: