Provider Demographics
NPI:1073096772
Name:ROBERTS, EMILY RUTH (BS, MS,)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:RUTH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:BS, MS,
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:RUTH
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:300 W ROSS ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5861
Mailing Address - Country:US
Mailing Address - Phone:505-360-7044
Mailing Address - Fax:
Practice Address - Street 1:701 MCCORMICK SCHOOL RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-7141
Practice Address - Country:US
Practice Address - Phone:505-599-8606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14194832OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
NMSLP6534OtherSPEECH-LANGUAGE PATHOLOGY, AUDIOLOGY, AND HEARING AID DISPENSING PRACTICES BOARD
NM380729OtherNEW MEXICO PUBLIC EDUCATION DEPARTMENT