Provider Demographics
NPI:1740498500
Name:ROGNER, STACY ANN (MS CCCSLPL)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:ROGNER
Suffix:
Gender:F
Credentials:MS CCCSLPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 N RIVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60051-8996
Mailing Address - Country:US
Mailing Address - Phone:630-788-5736
Mailing Address - Fax:815-679-6716
Practice Address - Street 1:4520 N RIVERDALE DR
Practice Address - Street 2:
Practice Address - City:JOHNSBURG
Practice Address - State:IL
Practice Address - Zip Code:60051-8996
Practice Address - Country:US
Practice Address - Phone:630-788-5736
Practice Address - Fax:815-679-6716
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL320012282OtherCORPORATE FEIN