MEDICARE: JONATHAN ROGERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	0000006043	TN

General Provider Information

NPI Number	:	1063054815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN ROGERS

Provider Business Mailing Address
First Line	:	2679 MORNING WOODS DR
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-4777
Country	:	US
Telephone Number	:	901-451-7795
Fax Number	:

Provider Business Practice Location Address
First Line	:	3960 NEW COVINGTON PIKE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2589
Country	:	US
Telephone Number	:	901-516-5200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2019
Last Update Date	:	10/14/2019

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Directions to “ JONATHAN ROGERS ” Practice Location

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