Provider Demographics
NPI:1316457591
Name:ROBERTS, DAMIEN K
Entity type:Individual
Prefix:
First Name:DAMIEN
Middle Name:K
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6390 RAGAN FARM DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-8329
Mailing Address - Country:US
Mailing Address - Phone:901-230-1661
Mailing Address - Fax:
Practice Address - Street 1:6390 RAGAN FARM DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-8329
Practice Address - Country:US
Practice Address - Phone:901-230-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist