MEDICARE: KEYONI ROGERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS020318	PA

General Provider Information

NPI Number	:	1275013203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYONI ROGERS

Provider Business Mailing Address
First Line	:	140 E GLENSIDE AVE # 1027
Second Line	:
City	:	GLENSIDE
State	:	PA
Zip	:	19038-4534
Country	:	US
Telephone Number	:	267-730-4980
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 E GLENSIDE AVE # 1027
Second Line	:
City	:	GLENSIDE
State	:	PA
Zip	:	19038-4534
Country	:	US
Telephone Number	:	267-730-4980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	04/07/2026

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Directions to “ KEYONI ROGERS ” Practice Location

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