Provider Demographics
NPI:1194084145
Name:ROGERS, KELLY E (MS)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:E
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 B. AZALEA ST.
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901
Mailing Address - Country:US
Mailing Address - Phone:361-576-0884
Mailing Address - Fax:361-576-3257
Practice Address - Street 1:2903 B. AZALEA ST.
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-576-0884
Practice Address - Fax:361-576-3257
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist