Provider Demographics
NPI:1649816547
Name:RODGERS, NICOLE MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
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 1:5874 PICARDY DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-1180
Mailing Address - Country:US
Mailing Address - Phone:559-270-5350
Mailing Address - Fax:
Practice Address - Street 1:5874 PICARDY DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-1180
Practice Address - Country:US
Practice Address - Phone:559-270-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist