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General NPI Number Information
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NPI Number | 1801702402
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Entity Type | Organization
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Legal Business Name | GWENDOLYN ROGERS, LAC P-LLC
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Dates
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Enumeration Date | 08/22/2026
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Last Update Date | 08/22/2026
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Provider Practice Location Address
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Address Line | 31 ADAMS AVE STE 4
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City | ENDICOTT
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State | NY
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Zip | 13760-5734
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Country | US
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Telephone | 607-729-0591
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Fax |
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Provider Business Mailing Address
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Address Line | 1 JOHN ST
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City | ITHACA
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State | NY
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Zip | 14850-6350
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Country | US
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Telephone | 503-975-3256
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | GWENDOLYN ROGERS
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Credential | ND, LAC
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Telephone | 503-975-3256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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