Provider Demographics
NPI:1023607942
Name:ROGNSTAD, CARISSA (SLP)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:ROGNSTAD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:DAUPHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:6834 N FRIDAY RD
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61010-8821
Mailing Address - Country:US
Mailing Address - Phone:815-219-9153
Mailing Address - Fax:
Practice Address - Street 1:6834 N FRIDAY RD
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:IL
Practice Address - Zip Code:61010-8821
Practice Address - Country:US
Practice Address - Phone:815-219-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.015958235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist