Provider Demographics
NPI:1750916367
Name:ROGERS, LAUREN SAMANTHA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:SAMANTHA
Last Name:ROGERS
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 1:4262 W FIGARDEN DR APT 274
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-8630
Mailing Address - Country:US
Mailing Address - Phone:626-755-0738
Mailing Address - Fax:
Practice Address - Street 1:745 E LOCUST AVE STE 110
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3000
Practice Address - Country:US
Practice Address - Phone:559-801-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist