Provider Demographics
NPI:1588921423
Name:ROGERS, JENNA
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 LAKE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:HIGDEN
Mailing Address - State:AR
Mailing Address - Zip Code:72067-9336
Mailing Address - Country:US
Mailing Address - Phone:501-351-7113
Mailing Address - Fax:
Practice Address - Street 1:2080 HARRISON ST STE A
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7447
Practice Address - Country:US
Practice Address - Phone:501-351-7113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AR3259235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program