MEDICARE: CARRIE RODGERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2202004694	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861610685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE RODGERS

Provider Business Mailing Address
First Line	:	8321 LEETON LAKE DR
Second Line	:
City	:	WARRENTON
State	:	VA
Zip	:	20186-8750
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8321 LEETON LAKE DR
Second Line	:
City	:	WARRENTON
State	:	VA
Zip	:	20186-8750
Country	:	US
Telephone Number	:	757-615-8878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	04/02/2013

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Directions to “ CARRIE RODGERS ” Practice Location

Language	Start Address	Practice Location

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