MEDICARE: MRS. KENTREISHA RAYE 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	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1467743492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KENTREISHA RAYE ROGERS

Provider Business Mailing Address
First Line	:	1025 WILLOW TREE DR UNIT A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3368
Country	:	US
Telephone Number	:	702-806-2418
Fax Number	:

Provider Business Practice Location Address
First Line	:	4085 N RANCHO DR
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3466
Country	:	US
Telephone Number	:	702-349-8258
Fax Number	:

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

Provider Enumeration Date	:	04/25/2011
Last Update Date	:	04/25/2011

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