Provider Demographics
NPI:1093377699
Name:ROBERTS, ANNE MARIE V (MSC CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:V
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MSC CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 MERCY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94041-2202
Mailing Address - Country:US
Mailing Address - Phone:415-562-7056
Mailing Address - Fax:
Practice Address - Street 1:266 MERCY ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-2202
Practice Address - Country:US
Practice Address - Phone:415-562-7056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist