Provider Demographics
NPI:1972366284
Name:ROBERTSON, ELIZABETH DAWN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DAWN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 STEEPLECHASE DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GAP
Mailing Address - State:PA
Mailing Address - Zip Code:16823-9630
Mailing Address - Country:US
Mailing Address - Phone:814-592-7328
Mailing Address - Fax:
Practice Address - Street 1:22 CREE DR
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-2639
Practice Address - Country:US
Practice Address - Phone:570-748-9377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist