Provider Demographics
NPI:1366461105
Name:ROBERTS, DENISE ALEXANDRA (MS, CCC/A)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ALEXANDRA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS, CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1932
Mailing Address - Country:US
Mailing Address - Phone:330-929-6621
Mailing Address - Fax:
Practice Address - Street 1:34302 EUCLID AVE
Practice Address - Street 2:UNIT #4
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-3334
Practice Address - Country:US
Practice Address - Phone:440-942-3480
Practice Address - Fax:440-942-3451
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01314231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA01314OtherLICENSE