Provider Demographics
NPI:1821154535
Name:ROGERS, NANCY REBECCA BALDWIN (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:REBECCA BALDWIN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BROOKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-0792
Mailing Address - Country:US
Mailing Address - Phone:828-342-2610
Mailing Address - Fax:828-349-2656
Practice Address - Street 1:20 BROOKSHIRE LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-0792
Practice Address - Country:US
Practice Address - Phone:828-342-2610
Practice Address - Fax:828-349-2656
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA544119739AMedicaid