Provider Demographics
NPI:1891938478
Name:ROGGENBUCK, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ROGGENBUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 SAND BEACH RD
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-8817
Mailing Address - Country:US
Mailing Address - Phone:989-269-4327
Mailing Address - Fax:989-269-2251
Practice Address - Street 1:1252 SAND BEACH RD
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-8817
Practice Address - Country:US
Practice Address - Phone:989-269-4327
Practice Address - Fax:989-269-2251
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004921237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540C20026OtherBLUE CROSS BLUE SHIELD
MI540C21072OtherBLUE CROSS BLUE SHIELD OF MICHIGAN