Provider Demographics
NPI:1114516952
Name:ROBERTS, KAROL ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAROL
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KAROL
Other - Middle Name:ANN
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7845 GOLDFISH WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4526
Mailing Address - Country:US
Mailing Address - Phone:858-776-8655
Mailing Address - Fax:
Practice Address - Street 1:7845 GOLDFISH WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-4526
Practice Address - Country:US
Practice Address - Phone:858-776-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist