Provider Demographics
NPI:1538429345
Name:ROGERS, MARTHA ELIZABETH (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ELIZABETH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:MARTHA
Other - Middle Name:ELIZABETH
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3333 N ARGONNE DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3419
Mailing Address - Country:US
Mailing Address - Phone:414-378-9804
Mailing Address - Fax:
Practice Address - Street 1:3333 N ARGONNE DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-3419
Practice Address - Country:US
Practice Address - Phone:414-378-9804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI180 -154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist