Provider Demographics
NPI:1922352814
Name:ROGERS, ELIZABETH LAINE (AUD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LAINE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ALLISON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-7964
Mailing Address - Country:US
Mailing Address - Phone:606-528-9993
Mailing Address - Fax:606-528-5553
Practice Address - Street 1:200 ALLISON BLVD
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-7964
Practice Address - Country:US
Practice Address - Phone:606-528-9993
Practice Address - Fax:606-528-5553
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101932237600000X
KY100078231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY101932OtherKENTUCKY HEARING INSTRUMENT SPECIALIST LICENSE
KY7100243960Medicaid
KY100078OtherKENTUCKY AUDIOLOGY LICENSE
K093730Medicare PIN