MEDICARE: MS. TAMMY J ROBERTS MA, CCC-SLP

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	22002519	IN

General Provider Information

NPI Number	:	1790967040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMMY J ROBERTS MA, CCC-SLP

Provider Business Mailing Address
First Line	:	3823 S BUSHMILL DR
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-8943
Country	:	US
Telephone Number	:	812-325-1280
Fax Number	:

Provider Business Practice Location Address
First Line	:	3823 S BUSHMILL DR
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-8943
Country	:	US
Telephone Number	:	812-325-1280
Fax Number	:

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

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	11/28/2007

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