Provider Demographics
NPI:1326303587
Name:ROGERS, KAYCIE CHRISTINE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAYCIE
Middle Name:CHRISTINE
Last Name:ROGERS
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 1:1313 W ASH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4358
Mailing Address - Country:US
Mailing Address - Phone:580-512-4292
Mailing Address - Fax:
Practice Address - Street 1:1313 W ASH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4358
Practice Address - Country:US
Practice Address - Phone:580-512-4292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4456235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111408402Medicaid
TX111408402Medicaid