Provider Demographics
NPI:1851148860
Name:ROGERS, JENNIFER LETTIE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LETTIE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LETTIE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 GELLERT BLVD STE 118
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2690
Mailing Address - Country:US
Mailing Address - Phone:650-994-3410
Mailing Address - Fax:650-994-5587
Practice Address - Street 1:333 GELLERT BLVD STE 118
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2690
Practice Address - Country:US
Practice Address - Phone:650-994-3410
Practice Address - Fax:650-994-5587
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8950237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist