Provider Demographics
NPI:1316359102
Name:RODGERS, JESSICA ELISE (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ELISE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 OVERLOOK LN NE
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-9671
Mailing Address - Country:US
Mailing Address - Phone:330-627-5915
Mailing Address - Fax:
Practice Address - Street 1:252 3RD ST NE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-1236
Practice Address - Country:US
Practice Address - Phone:330-627-4592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 7523235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist