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General NPI Number Information
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NPI Number | 1316005408
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Entity Type | Individual
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Provider Name | BRANDI LEIGH ROGERS LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 3101 W 2ND CT
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-4504
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Country | US
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Telephone | 479-567-5654
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Fax | 479-567-5661
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Provider Business Mailing Address
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Address Line | PO BOX 10323
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City | RUSSELLVILLE
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State | AR
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Zip | 72812-0323
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Country | US
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Telephone | 479-567-5654
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Fax | 479-567-5661
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2697-M
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5470-C
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License Number State | AR
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