Provider Demographics
NPI:1124251533
Name:ROBERSON, KEVIN LEE (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LEE
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7903 JOLIET AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1719
Mailing Address - Country:US
Mailing Address - Phone:806-780-3218
Mailing Address - Fax:
Practice Address - Street 1:8207 HUDSON AVE STE A
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2805
Practice Address - Country:US
Practice Address - Phone:806-792-6135
Practice Address - Fax:806-792-4945
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19091235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist