Provider Demographics
NPI:1689652067
Name:ROGERS, PATRICIA ANNE (MA)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANNE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:ANNE
Other - Last Name:SEYMOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:10588 CANTERBERRY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-1930
Mailing Address - Country:US
Mailing Address - Phone:703-924-4148
Mailing Address - Fax:703-922-5048
Practice Address - Street 1:2824 SYRACUSE CT
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2454
Practice Address - Country:US
Practice Address - Phone:703-924-4148
Practice Address - Fax:703-922-0638
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA220200536OtherBOARD OF AUDIOLOGY
MD02628OtherDEPT OF HEALTH SPEECH
CO23751215Medicaid