Provider Demographics
NPI:1528886207
Name:ROGERS MENDOZA, ALICE M (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:M
Last Name:ROGERS MENDOZA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 MUSTANG CHASE DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8180
Mailing Address - Country:US
Mailing Address - Phone:215-205-2728
Mailing Address - Fax:
Practice Address - Street 1:2022 MUSTANG CHASE DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46074-8180
Practice Address - Country:US
Practice Address - Phone:215-205-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22008487A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist