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NPI Code Detail

MEDICARE: MARYBETH F ROBERTSON SLP-CCC MS

MEDICARE: MARYBETH F ROBERTSON SLP-CCC MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist10775121-4102UT

General Provider Information

NPI Number : 1538827191
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYBETH F ROBERTSON SLP-CCC MS
Provider Business Mailing Address
First Line : 521 MEADOWLARK RD
Second Line :
City : OREM
State : UT
Zip : 84097-2305
Country : US
Telephone Number : 801-369-3583
Fax Number :
Provider Business Practice Location Address
First Line : 345 E GATEWAY DR STE 150
Second Line :
City : HEBER CITY
State : UT
Zip : 84032-4625
Country : US
Telephone Number : 801-494-7208
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2021
Last Update Date : 12/01/2021

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Directions to “ MARYBETH F ROBERTSON SLP-CCC MS” Practice Location

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