Provider Demographics
NPI:1407360613
Name:ROGERS, VICTORIA MARIE (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6307
Mailing Address - Fax:
Practice Address - Street 1:249 N GROVE MEDICAL PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4227
Practice Address - Country:US
Practice Address - Phone:864-598-0420
Practice Address - Fax:864-596-5164
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6144235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist