Provider Demographics
NPI:1134168818
Name:ROGERS, DOROTHY ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ELIZABETH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:ELIZABETH
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2525 S 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-1328
Mailing Address - Country:US
Mailing Address - Phone:406-396-3500
Mailing Address - Fax:406-258-0634
Practice Address - Street 1:2525 S 3RD ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-1328
Practice Address - Country:US
Practice Address - Phone:406-396-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT656LCSW101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0503711Medicaid
MT71125OtherBCBS MT
MT71125OtherBCBS MT