Provider Demographics
NPI:1033760111
Name:ROGOVER, NORMAN
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:
Last Name:ROGOVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 PALM HARBOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1413
Mailing Address - Country:US
Mailing Address - Phone:727-682-0056
Mailing Address - Fax:727-935-4844
Practice Address - Street 1:10929 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-3747
Practice Address - Country:US
Practice Address - Phone:727-682-0056
Practice Address - Fax:727-935-4844
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1306082276Medicaid