Provider Demographics
NPI:1487861472
Name:ROGERS, JENNIFER CHRISTINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CHRISTINE
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 1:116 VALDERRAMA DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-8971
Mailing Address - Country:US
Mailing Address - Phone:501-249-8649
Mailing Address - Fax:501-776-3652
Practice Address - Street 1:116 VALDERRAMA DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-8971
Practice Address - Country:US
Practice Address - Phone:501-249-8649
Practice Address - Fax:501-776-3652
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist