Provider Demographics
NPI:1043737950
Name:ROGERS, DANIELLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 DEARBORN AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2503
Mailing Address - Country:US
Mailing Address - Phone:419-345-1161
Mailing Address - Fax:
Practice Address - Street 1:445 E MANHATTAN BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1268
Practice Address - Country:US
Practice Address - Phone:419-671-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.10875235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist