Provider Demographics
NPI:1144707308
Name:ROGERS, MICHELLE GAY (MA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GAY
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11310 NE 177TH PL
Mailing Address - Street 2:361
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072
Mailing Address - Country:US
Mailing Address - Phone:857-203-0086
Mailing Address - Fax:
Practice Address - Street 1:1611 116TH AVE NE STE 127
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3063
Practice Address - Country:US
Practice Address - Phone:617-620-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60868955101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health