Provider Demographics
NPI:1841772613
Name:ROGERS, KATIE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
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 1:400 E HUDSON ST # 317
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2434
Mailing Address - Country:US
Mailing Address - Phone:605-717-1201
Mailing Address - Fax:
Practice Address - Street 1:400 E HUDSON ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2434
Practice Address - Country:US
Practice Address - Phone:605-717-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD688235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty