Provider Demographics
NPI:1205907839
Name:ROGERS, JUDITH PHILLIPS (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:PHILLIPS
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1524
Mailing Address - Country:US
Mailing Address - Phone:334-263-4844
Mailing Address - Fax:334-264-8129
Practice Address - Street 1:1728 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1524
Practice Address - Country:US
Practice Address - Phone:334-263-4844
Practice Address - Fax:334-264-8129
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL310103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-23126OtherBCBS VENDOR ID NUMBER