Provider Demographics
NPI:1235254822
Name:ROBERTI, GRACIELA (MSSLP)
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:ROBERTI
Suffix:
Gender:F
Credentials:MSSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SUMMERGLOW CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8308
Mailing Address - Country:US
Mailing Address - Phone:919-621-5770
Mailing Address - Fax:919-342-6443
Practice Address - Street 1:103 SUMMERGLOW CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8308
Practice Address - Country:US
Practice Address - Phone:919-621-5770
Practice Address - Fax:919-342-6443
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412475Medicaid