Individual
MS. JESSICA RODGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
905 N GURLEY AVE, GILLETTE, WY 82716-2109
(307) 686-0669
Mailing address
1122 E 12TH ST, GILLETTE, WY 82716-5078
(608) 475-0544
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336393834
—
WY
Enumeration date
05/21/2015
Last updated
07/07/2015
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