Provider Demographics
NPI:1225461007
Name:ROBERSON, JUDITH E (CCSP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:E
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ELDERBERRY CT
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-2131
Mailing Address - Country:US
Mailing Address - Phone:302-234-9226
Mailing Address - Fax:
Practice Address - Street 1:15 ELDERBERRY CT
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-2131
Practice Address - Country:US
Practice Address - Phone:302-234-9226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO1-0000018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist