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Individual

KELLY ROBERTSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.A. CCC/SLP

Contact information

Practice address
188 EVERGREEN RD, LAKE WYLIE, SC 29710-9001
(407) 690-2056
Mailing address
188 EVERGREEN RD, LAKE WYLIE, SC 29710-9001
(407) 690-2056

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5367
SC
235Z00000X
Speech-Language Pathologist
SA 9884
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001155200
FL
Enumeration date
02/26/2010
Last updated
02/28/2014
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