Individual
RONIESHA ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
277 CUBA ST, HOLLY SPRINGS, MS 38635-2102
(662) 291-0031
Mailing address
277 CUBA ST, HOLLY SPRINGS, MS 38635-2102
(662) 291-0031
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
121854201
DRIVERS LICENSE
TN
Enumeration date
04/26/2018
Last updated
04/26/2018
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