Provider Demographics
NPI:1740154053
Name:ROGERS, MORIAH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MORIAH
Middle Name:
Last Name:ROGERS
Suffix:
Gender:X
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2885 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4808
Mailing Address - Country:US
Mailing Address - Phone:707-443-1627
Mailing Address - Fax:
Practice Address - Street 1:2885 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4808
Practice Address - Country:US
Practice Address - Phone:707-443-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39042235Z00000X
TX121360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist