Provider Demographics
NPI:1457707606
Name:ROGERS, LAURA (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
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 1:11873 SUNCHASE COURT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498
Mailing Address - Country:US
Mailing Address - Phone:561-719-4324
Mailing Address - Fax:
Practice Address - Street 1:11873 SUNCHASE CT
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6815
Practice Address - Country:US
Practice Address - Phone:561-719-4324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA9155Medicaid