Provider Demographics
NPI:1952327298
Name:ROGAN, MELISSA P (MACCSLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:P
Last Name:ROGAN
Suffix:
Gender:F
Credentials:MACCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 YORK RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5445
Mailing Address - Country:US
Mailing Address - Phone:336-760-3365
Mailing Address - Fax:336-760-3365
Practice Address - Street 1:3309 YORK RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5445
Practice Address - Country:US
Practice Address - Phone:336-760-3365
Practice Address - Fax:336-760-3365
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC588235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7472921Medicaid