Provider Demographics
NPI:1144705377
Name:ROGERS, AVERY DIOR (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:DIOR
Last Name:ROGERS
Suffix:
Gender:F
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 1:2156 DEEP WATER LN STE 110
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8507
Mailing Address - Country:US
Mailing Address - Phone:630-904-0700
Mailing Address - Fax:
Practice Address - Street 1:2156 DEEP WATER LN STE 110
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8507
Practice Address - Country:US
Practice Address - Phone:630-904-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.014543235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist