Provider Demographics
NPI:1588693303
Name:ROBY, RACHELLE LIZETTE (MS, CCC/SP)
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:LIZETTE
Last Name:ROBY
Suffix:
Gender:F
Credentials:MS, CCC/SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41651 NEEDLEROCK RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:CO
Mailing Address - Zip Code:81415
Mailing Address - Country:US
Mailing Address - Phone:970-921-5312
Mailing Address - Fax:970-921-5312
Practice Address - Street 1:41651 NEEDLEROCK RD
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:CO
Practice Address - Zip Code:81415
Practice Address - Country:US
Practice Address - Phone:970-921-5312
Practice Address - Fax:970-921-5312
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3690235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07010622Medicaid