Provider Demographics
NPI:1215664453
Name:ROBERTSON, TRENA A (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TRENA
Middle Name:A
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 SEVENOAKS AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7324
Mailing Address - Country:US
Mailing Address - Phone:225-929-8600
Mailing Address - Fax:
Practice Address - Street 1:6550 SEVENOAKS AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7324
Practice Address - Country:US
Practice Address - Phone:225-929-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist