Healthcare Provider Details

I. General information

NPI: 1073096772
Provider Name (Legal Business Name): EMILY RUTH ROBERTS BS, MS,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY RUTH HARRISON BS.

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MCCORMICK SCHOOL RD
FARMINGTON NM
87401-7141
US

IV. Provider business mailing address

300 W ROSS ST
FARMINGTON NM
87401-5861
US

V. Phone/Fax

Practice location:
  • Phone: 505-599-8606
  • Fax:
Mailing address:
  • Phone: 505-360-7044
  • 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: