Provider Demographics
NPI:1235413402
Name:ROGGOW, RAE ANNE M (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:RAE ANNE
Middle Name:M
Last Name:ROGGOW
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 1:3846 FRITZ RD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1393
Mailing Address - Country:US
Mailing Address - Phone:716-692-1737
Mailing Address - Fax:
Practice Address - Street 1:2292 SAUNDERS SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:SANBORN
Practice Address - State:NY
Practice Address - Zip Code:14132-9521
Practice Address - Country:US
Practice Address - Phone:716-215-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015589235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist