Provider Demographics
NPI:1194565366
Name:ROBERTS, EMILY REBECCA
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:REBECCA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:HAMER
Mailing Address - State:SC
Mailing Address - Zip Code:29547-0338
Mailing Address - Country:US
Mailing Address - Phone:843-632-1774
Mailing Address - Fax:
Practice Address - Street 1:736 JACK RUSSELL CT
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8356
Practice Address - Country:US
Practice Address - Phone:803-354-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist