Provider Demographics
NPI:1508201989
Name:ROGERS, KAREN GULLEDGE (LPES)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:GULLEDGE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 COLIE EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:RUBY
Mailing Address - State:SC
Mailing Address - Zip Code:29741-6735
Mailing Address - Country:US
Mailing Address - Phone:843-634-6806
Mailing Address - Fax:
Practice Address - Street 1:401 WEST BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:SC
Practice Address - Zip Code:29709-1534
Practice Address - Country:US
Practice Address - Phone:843-623-5541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3061251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)