Provider Demographics
NPI:1306576301
Name:ROBERTS, ALISON NICOLE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:NICOLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:NICOLE
Other - Last Name:BLOSSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CALVERT CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42029-8233
Mailing Address - Country:US
Mailing Address - Phone:270-395-4124
Mailing Address - Fax:
Practice Address - Street 1:1201 5TH AVE
Practice Address - Street 2:
Practice Address - City:CALVERT CITY
Practice Address - State:KY
Practice Address - Zip Code:42029-8233
Practice Address - Country:US
Practice Address - Phone:270-395-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY265366235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist