Provider Demographics
NPI:1801129465
Name:ROGERS, STEPHANIE (MSW U/S)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MSW U/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20426 E 47TH ST S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-8825
Mailing Address - Country:US
Mailing Address - Phone:918-706-8715
Mailing Address - Fax:
Practice Address - Street 1:1305 S COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-7802
Practice Address - Country:US
Practice Address - Phone:918-686-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200367220BMedicaid