Provider Demographics
NPI:1760617591
Name:ROGERS, ELIZABETH ROSE (MS)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ROSE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SINICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:229 JENKINS RANCH RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:315-406-8222
Mailing Address - Fax:315-218-7466
Practice Address - Street 1:229 JENKINS RANCH RD
Practice Address - Street 2:UNIT A
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:315-406-8222
Practice Address - Fax:315-218-7466
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
CO0004667235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist