Provider Demographics
NPI:1508812884
Name:ROGERS, MICHELE L (AUD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:ROGERS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8339
Mailing Address - Country:US
Mailing Address - Phone:580-536-8844
Mailing Address - Fax:580-536-8818
Practice Address - Street 1:4920 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8339
Practice Address - Country:US
Practice Address - Phone:580-536-8844
Practice Address - Fax:580-536-8818
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK299231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK299OtherAUDIOLOGY LICENCE