Provider Demographics
NPI:1922720341
Name:ROGERS, LESA CAROL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LESA
Middle Name:CAROL
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 1:3311 MOUNTAIN VISTA RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-9600
Mailing Address - Country:US
Mailing Address - Phone:870-365-5365
Mailing Address - Fax:
Practice Address - Street 1:3311 MOUNTAIN VISTA RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-9600
Practice Address - Country:US
Practice Address - Phone:870-365-5365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist