Provider Demographics
NPI:1740025394
Name:ROGAN, MOLLIE ROSE (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:ROSE
Last Name:ROGAN
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WILLISTON DR
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-2110
Mailing Address - Country:US
Mailing Address - Phone:636-288-9920
Mailing Address - Fax:
Practice Address - Street 1:56 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3802
Practice Address - Country:US
Practice Address - Phone:860-217-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18.007756-TEMP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist