Healthcare Provider Details

I. General information

NPI: 1821233255
Provider Name (Legal Business Name): LORI ANN ROBERTSON MS, CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204-09 8TH AVE.
ROCKAWAY POINT NY
11697
US

IV. Provider business mailing address

204-09 8TH AVE.
ROCKAWAY POINT NY
11697
US

V. Phone/Fax

Practice location:
  • Phone: 718-551-2556
  • Fax:
Mailing address:
  • Phone: 718-551-2556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number017198
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: