Provider Demographics
NPI:1164751236
Name:ROGANOVICH, COLLEEN ANN (SLP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANN
Last Name:ROGANOVICH
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 1:4003 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2092
Mailing Address - Country:US
Mailing Address - Phone:219-476-0023
Mailing Address - Fax:
Practice Address - Street 1:4003 VICTORIA DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2092
Practice Address - Country:US
Practice Address - Phone:219-476-0023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001963A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist