Provider Demographics
NPI:1003059023
Name:ROBERTSON, VALERIE JILL (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:JILL
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 CEDAR BND
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-1082
Mailing Address - Country:US
Mailing Address - Phone:765-621-1593
Mailing Address - Fax:
Practice Address - Street 1:2311 CEDAR BND
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-1082
Practice Address - Country:US
Practice Address - Phone:765-621-1593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003210A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist