Healthcare Provider Details

I. General information

NPI: 1740734151
Provider Name (Legal Business Name): LEAH ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH FEDDE

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 E POINTER TRL
VAN BUREN AR
72956-2336
US

IV. Provider business mailing address

3227 EDINBURGH DR
FORT SMITH AR
72908-9215
US

V. Phone/Fax

Practice location:
  • Phone: 479-474-7956
  • Fax:
Mailing address:
  • Phone: 918-315-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4248
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: