Provider Demographics
NPI:1316118441
Name:ROGERS, DELISA DOLORES (SLP)
Entity type:Individual
Prefix:
First Name:DELISA
Middle Name:DOLORES
Last Name:ROGERS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 WIGGINGTON RD UNIT 300
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5194
Mailing Address - Country:US
Mailing Address - Phone:434-996-7494
Mailing Address - Fax:
Practice Address - Street 1:2200 LANDOVER PL
Practice Address - Street 2:HCR MANORCARE
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2116
Practice Address - Country:US
Practice Address - Phone:434-996-7494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005447235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004909976Medicaid