Provider Demographics
NPI:1548582315
Name:ROGERS, GEORGIANA (BS NA ED S)
Entity Type:Individual
Prefix:
First Name:GEORGIANA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:BS NA ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8766 E. HWY 69
Mailing Address - Street 2:HUMBOLDT UNIFIED SCHOOL DISTRICT/SSO
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314
Mailing Address - Country:US
Mailing Address - Phone:928-759-4042
Mailing Address - Fax:928-759-4030
Practice Address - Street 1:8766 E. HWY 69
Practice Address - Street 2:HUMBOLDT UNIFIED SCHOOL DISTRICT/SSO
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-759-4042
Practice Address - Fax:928-759-4030
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP6087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist