Healthcare Provider Details

I. General information

NPI: 1538429345
Provider Name (Legal Business Name): MARTHA ELIZABETH ROGERS MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARTHA ELIZABETH ROGERS MS, CCC-SLP

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 N ARGONNE DR
MILWAUKEE WI
53222-3419
US

IV. Provider business mailing address

3333 N ARGONNE DR
MILWAUKEE WI
53222-3419
US

V. Phone/Fax

Practice location:
  • Phone: 414-378-9804
  • Fax:
Mailing address:
  • Phone: 414-378-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number180 -154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: