Provider Demographics
NPI:1386970101
Name:WASSON, ROBERTA JEAN
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:JEAN
Last Name:WASSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ROBERTA
Other - Middle Name:JEAN
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 EVERETT ROAD EXT.
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205
Mailing Address - Country:US
Mailing Address - Phone:518-435-1400
Mailing Address - Fax:
Practice Address - Street 1:21 EVERETT ROAD EXT.
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-435-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150237600000X
NY14000014850237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter