Provider Demographics
NPI:1093832719
Name:ROBERTS, JULIE RAY (PHD, CCC-SLP,BCBA-D)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:RAY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHD, CCC-SLP,BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAGNOLIA RESERVE LOOP
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-3868
Mailing Address - Country:US
Mailing Address - Phone:972-951-7909
Mailing Address - Fax:
Practice Address - Street 1:200 MAGNOLIA RESERVE LOOP
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-3868
Practice Address - Country:US
Practice Address - Phone:972-951-7909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist