Healthcare Provider Details

I. General information

NPI: 1326162488
Provider Name (Legal Business Name): KIM G. ROGERS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 8 EAST
AMITY AR
71921
US

IV. Provider business mailing address

324 PERRY ST
GLENWOOD AR
71943-9518
US

V. Phone/Fax

Practice location:
  • Phone: 870-356-3612
  • Fax:
Mailing address:
  • Phone: 870-356-4328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1487
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: