Healthcare Provider Details

I. General information

NPI: 1346166881
Provider Name (Legal Business Name): NATHAN ROGERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 W BROAD ST
COLUMBUS OH
43204-2653
US

IV. Provider business mailing address

140 E TOWN ST STE 1450
COLUMBUS OH
43215-6601
US

V. Phone/Fax

Practice location:
  • Phone: 614-639-5578
  • Fax:
Mailing address:
  • Phone: 614-639-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.193744
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: