Provider Demographics
NPI:1841248614
Name:RODGERS, SALLY BETH (AUD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:BETH
Last Name:RODGERS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1805
Mailing Address - Country:US
Mailing Address - Phone:509-698-3787
Mailing Address - Fax:
Practice Address - Street 1:303 S 12TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3112
Practice Address - Country:US
Practice Address - Phone:509-453-8248
Practice Address - Fax:509-248-9012
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001017231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7098684Medicaid
WA9079203Medicaid