Individual
MS. KHANEDRA EDWARDS ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,CCC-SLP
Contact information
Practice address
2812 CUMBERLAND DR APT 1G, VALPARAISO, IN 46383-2532
(219) 331-9514
Mailing address
PO BOX 812, PORTAGE, IN 46368-0812
(219) 331-9514
(219) 939-0020
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22003661A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200340020A
—
IN
01
—
200726320
SPEECH PATHOLOGIST
IN
Enumeration date
01/14/2007
Last updated
03/31/2020
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