Healthcare Provider Details

I. General information

NPI: 1326679143
Provider Name (Legal Business Name): ELISABETH ROBERTSON MA. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227B BENDEL RD. STE. C
LAFAYETTE LA
70503
US

IV. Provider business mailing address

1019 MONTORSE BLVD
LAFAYETTE LA
70503
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-9940
  • Fax: 337-981-2531
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7728
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: