Individual
MRS. DONETTA R ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
10668 LYDIA LN, DANVILLE, AR 72833-6890
(479) 496-6326
(473) 495-3336
Mailing address
1902 W 2ND PL, RUSSELLVILLE, AR 72801-4612
(479) 567-5746
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP2612
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09139851
AMERICAN ST, LANG, ASSOC
AR
05
—
170086721
—
AR
01
—
SP2612
AR STATE LICENSE
AR
Enumeration date
10/16/2008
Last updated
10/16/2008
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