Provider Demographics
NPI:1629526330
Name:ROGERS, LYDIA ROSADO (AUD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ROSADO
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 1:3924 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2775
Mailing Address - Country:US
Mailing Address - Phone:509-380-7044
Mailing Address - Fax:
Practice Address - Street 1:3924 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-2775
Practice Address - Country:US
Practice Address - Phone:509-380-7044
Practice Address - Fax:509-544-5792
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP-1120-AU231H00000X
WALD60757600231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist