Provider Demographics
NPI:1699914556
Name:ROGSTAD, CARLA
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:ROGSTAD
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 1:1810 CREST VIEW DR STE 3A
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-9313
Mailing Address - Country:US
Mailing Address - Phone:715-716-5142
Mailing Address - Fax:715-808-8162
Practice Address - Street 1:1810 CREST VIEW DR STE 3A
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-9313
Practice Address - Country:US
Practice Address - Phone:715-716-5142
Practice Address - Fax:715-808-8162
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1241237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist