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General NPI Number Information
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NPI Number | 1861893075
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Entity Type | Individual
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Provider Name | KELLY C. ROBERTS SLPA
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Gender | Female
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Dates
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Enumeration Date | 09/07/2014
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 15802 N PARKVIEW PL
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City | SURPRISE
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State | AZ
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Zip | 85374-7466
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Country | US
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Telephone | 951-867-8229
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Fax |
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Provider Business Mailing Address
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Address Line | 14214 W YOSEMITE DR
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-5647
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Country | US
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Telephone | 951-867-8229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SLPA13214
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SPA2495
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License Number State | CA
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