Provider Demographics
NPI:1164997482
Name:ROBERTS, CHRISTINE A (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17008 LOFTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-6212
Mailing Address - Country:US
Mailing Address - Phone:571-248-6925
Mailing Address - Fax:
Practice Address - Street 1:1481 SENSENY RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-6421
Practice Address - Country:US
Practice Address - Phone:540-665-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-13
Last Update Date:2018-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist