Healthcare Provider Details

I. General information

NPI: 1356630081
Provider Name (Legal Business Name): EMILY ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 HIGHWAY 64 E
ALMA AR
72921
US

IV. Provider business mailing address

2904 LAKEVIEW PT
FORT SMITH AR
72903-5475
US

V. Phone/Fax

Practice location:
  • Phone: 479-632-3813
  • Fax:
Mailing address:
  • Phone: 479-653-7380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: