Provider Demographics
NPI:1184199176
Name:ROGERS, SELMA LEA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SELMA
Middle Name:LEA
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 W MATTHEW
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-2118
Mailing Address - Country:US
Mailing Address - Phone:918-314-3479
Mailing Address - Fax:
Practice Address - Street 1:507 W MATTHEW
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-2118
Practice Address - Country:US
Practice Address - Phone:918-314-3479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4715235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist