Provider Demographics
NPI:1700972510
Name:RODGERS, PATRICIA LOUISE (MACCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:LOUISE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 E VICTORIA RD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-9289
Mailing Address - Country:US
Mailing Address - Phone:573-686-5216
Mailing Address - Fax:573-686-5216
Practice Address - Street 1:2400 E VICTORIA RD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-9289
Practice Address - Country:US
Practice Address - Phone:573-686-5216
Practice Address - Fax:573-686-5216
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01924235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist