Provider Demographics
NPI:1811052780
Name:RODGERS, KHORTNI H (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KHORTNI
Middle Name:H
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 1:9047 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4605
Mailing Address - Country:US
Mailing Address - Phone:865-539-1928
Mailing Address - Fax:865-539-6461
Practice Address - Street 1:9047 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 115
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4605
Practice Address - Country:US
Practice Address - Phone:865-539-1928
Practice Address - Fax:865-539-6461
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000003817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist