Provider Demographics
NPI:1134798812
Name:RODGERS, JANSEN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANSEN
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 HEATHER HILL DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7998
Mailing Address - Country:US
Mailing Address - Phone:810-397-0307
Mailing Address - Fax:
Practice Address - Street 1:15930 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1155
Practice Address - Country:US
Practice Address - Phone:586-286-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007924235Z00000X
MI7152000066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist