Provider Demographics
NPI:1114656170
Name:ROGERS, KATELYN (SLP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2996 OAK ST APT 205
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-3391
Mailing Address - Country:US
Mailing Address - Phone:417-770-0090
Mailing Address - Fax:
Practice Address - Street 1:1731 N 90TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1515
Practice Address - Country:US
Practice Address - Phone:913-732-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist