Basic Information
| Provider Information | |||||||||
| NPI: | 1184341943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | BETSY | ||||||||
| MiddleName: | PAIGE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3203 COLUMBUS ST | ||||||||
| Address2: | |||||||||
| City: | GROVE CITY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431233242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146346735 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4664 LARWELL DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432203621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144877805 | ||||||||
| FaxNumber: | 6144877809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2022 | ||||||||
| LastUpdateDate: | 10/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | I.1700610-SUPV-S | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.