MEDICARE: RUTH ELLEN ROBERTS MACCCSLP

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
1	235Z00000X	Speech-Language Pathologist	000783	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790788073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH ELLEN ROBERTS MACCCSLP

Provider Business Mailing Address
First Line	:	226 ALCOVY ST
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-2183
Country	:	US
Telephone Number	:	770-207-9043
Fax Number	:	770-207-9029

Provider Business Practice Location Address
First Line	:	226 ALCOVY ST
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-2183
Country	:	US
Telephone Number	:	770-207-9043
Fax Number	:	770-207-9029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/09/2007

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Directions to “ RUTH ELLEN ROBERTS MACCCSLP” Practice Location

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