Individual
JACLYN ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1493 CAMBRIDGE ST, CAMBRIDGE, MA 02139-1047
(518) 368-7107
Mailing address
1493 CAMBRIDGE ST, CAMBRIDGE, MA 02139-1047
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA8180
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2020
Last updated
11/02/2021
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