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NPI Code Detail

MEDICARE: MS. STACEY SIMONSON ROGERS MHR

MEDICARE: MS. STACEY SIMONSON ROGERS MHR
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1811227143
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. STACEY SIMONSON ROGERS MHR
Provider Business Mailing Address
First Line : 11015 S 85TH EAST AVE
Second Line : A
City : TULSA
State : OK
Zip : 74133-7308
Country : US
Telephone Number : 918-639-7460
Fax Number :
Provider Business Practice Location Address
First Line : 5656 S 129TH EAST AVE
Second Line :
City : TULSA
State : OK
Zip : 74134-6715
Country : US
Telephone Number : 918-357-7003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2010
Last Update Date : 02/23/2011

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