Healthcare Provider Details

I. General information

NPI: 1083344279
Provider Name (Legal Business Name): ELIZABETH JEAN ROGERS M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 GARDENA CT
SPRINGFIELD OH
45503-5602
US

IV. Provider business mailing address

1311 GARDENA CT
SPRINGFIELD OH
45503-5602
US

V. Phone/Fax

Practice location:
  • Phone: 330-421-9077
  • Fax:
Mailing address:
  • Phone: 330-421-9077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: