MEDICARE: JACQUELINE ROGERS LCSW

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	104100000X	Social Worker	LCSW-18195	AZ

General Provider Information

NPI Number	:	1295371342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE ROGERS LCSW

Provider Business Mailing Address
First Line	:	3620 N 3RD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2020
Country	:	US
Telephone Number	:	602-230-7373
Fax Number	:

Provider Business Practice Location Address
First Line	:	9014 S CENTRAL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-8304
Country	:	US
Telephone Number	:	602-230-7373
Fax Number	:

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

Provider Enumeration Date	:	11/25/2019
Last Update Date	:	11/02/2023

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