Provider Demographics
NPI:1972216414
Name:ROGERS, JESSICA (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1705
Mailing Address - Country:US
Mailing Address - Phone:573-983-4730
Mailing Address - Fax:573-240-9949
Practice Address - Street 1:11 S DIVISION ST STE A
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-1701
Practice Address - Country:US
Practice Address - Phone:573-723-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022049316101YM0800X, 101YP2500X
MO2025027027101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health