Healthcare Provider Details

I. General information

NPI: 1992326920
Provider Name (Legal Business Name): SARAJANE ELIZABETH RODGERS MS, MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 GENERAL WARREN BLVD STE 101
MALVERN PA
19355-1245
US

IV. Provider business mailing address

5370 POND MOUNTAIN RD
BROAD RUN VA
20137-2026
US

V. Phone/Fax

Practice location:
  • Phone: 484-870-5608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: