Provider Demographics
NPI:1326162488
Name:ROGERS, KIM G (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:G
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 1:324 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:71943-9518
Mailing Address - Country:US
Mailing Address - Phone:870-356-4328
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 8 EAST
Practice Address - Street 2:
Practice Address - City:AMITY
Practice Address - State:AR
Practice Address - Zip Code:71921
Practice Address - Country:US
Practice Address - Phone:870-356-3612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist