Provider Demographics
NPI:1548542913
Name:RODGERS, JENNIFER G (MSR, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MSR, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 RIVER WAY DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-6861
Mailing Address - Country:US
Mailing Address - Phone:864-346-4318
Mailing Address - Fax:
Practice Address - Street 1:10 RIVER WAY DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-6861
Practice Address - Country:US
Practice Address - Phone:864-346-4318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3184235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist