MEDICARE: MIKELL ROBERTS M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist		NV

General Provider Information

NPI Number	:	1306712088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKELL ROBERTS M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	6164 BAYARD ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4741
Country	:	US
Telephone Number	:	702-877-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	2810 W CHARLESTON BLVD STE F53
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1906
Country	:	US
Telephone Number	:	702-877-0808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2025
Last Update Date	:	10/11/2025

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