Provider Demographics
NPI:1174846497
Name:ROGERS, JONI (MED)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4854
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765-4854
Mailing Address - Country:US
Mailing Address - Phone:512-961-9936
Mailing Address - Fax:
Practice Address - Street 1:3500 OAKMONT BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6009
Practice Address - Country:US
Practice Address - Phone:512-346-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104296235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist