Provider Information for 1982134441
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GLENNA RODGERS LPC, CRC
Other Names:Former Name:GLENNA EDWARDSSex: Female
NPI: 1982134441
Last Updated: 2021-06-22
Certification Date: 2021-06-22
Certification Date: 2021-06-22
Details
Name | Value | ||||||||||||
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NPI | 1982134441 | ||||||||||||
Enumeration Date | 2017-06-18 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | NO | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 2809 FOREST HOME RD JONESBORO, AR 72401-5320 United States Phone: 866-972-1268 | Fax: | ||||||||||||
Primary Practice Address | 4001 COMMERCIAL CENTER DR STE 2 MARION, AR 72364-9616 United States Phone: 870-732-7920 | Fax:870-732-7923 | ||||||||||||
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