Healthcare Provider Details

I. General information

NPI: 1063339018
Provider Name (Legal Business Name): JENNY LEE ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 MOORE ST APT B
FREMONT OH
43420-1709
US

IV. Provider business mailing address

1116 MOORE ST APT B
FREMONT OH
43420-1709
US

V. Phone/Fax

Practice location:
  • Phone: 419-603-1899
  • Fax:
Mailing address:
  • Phone: 419-603-1899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number7200522
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: