Basic Information
| Provider Information | |||||||||
| NPI: | 1093203630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROGGE | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6784 CYPRESS DR | ||||||||
| Address2: | |||||||||
| City: | NORTH OLMSTED | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440705121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407934065 | ||||||||
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| Practice Location | |||||||||
| Address1: | 346 ILLINOIS AVE | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402880448 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2018 | ||||||||
| LastUpdateDate: | 08/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP.13207 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.