=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972642882
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROYAL FLORENCE WARNEMENT-ROGERS M.S.,CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 03/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1450 S WOODLAND BLVD
-----------------------------------------------------
City | DELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32720-7767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-873-3658
-----------------------------------------------------
Fax | 386-490-1037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3055 KINGSTREE DR
-----------------------------------------------------
City | DELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32724-4900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-738-0087
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 222Q00000X
-----------------------------------------------------
Taxonomy Name | Developmental Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SA429
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------