Individual
MRS. SUSAN RAEANN ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
200 GASTON AVE, FAIRMONT, WV 26554-2739
(304) 624-6554
(304) 624-6554
Mailing address
200 GASTON AVE, FAIRMONT, WV 26554-2739
(304) 624-6554
(304) 624-6554
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810012200
—
WV
Enumeration date
11/24/2008
Last updated
11/24/2008
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