Provider Demographics
NPI:1114395993
Name:ROBERTSON, JULIE (CCC-SLP, MS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CCC-SLP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:204 MADRID ST
Mailing Address - City:ELSIE
Mailing Address - State:NE
Mailing Address - Zip Code:69134-0063
Mailing Address - Country:US
Mailing Address - Phone:308-289-6858
Mailing Address - Fax:
Practice Address - Street 1:314 W 1ST ST
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-2520
Practice Address - Country:US
Practice Address - Phone:308-284-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist