Provider Demographics
NPI:1275824005
Name:ROBERTS, DIANE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 E KENYON AVE STE 2600
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1898
Mailing Address - Country:US
Mailing Address - Phone:720-545-2045
Mailing Address - Fax:303-955-6660
Practice Address - Street 1:9101 E KENYON AVE STE 2600
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1898
Practice Address - Country:US
Practice Address - Phone:720-545-2045
Practice Address - Fax:303-955-6660
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-3736235Z00000X
235Z00000X
CO0000113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVSP-3736OtherNEVADA SLP, AUDIOLOGY, HA DISPENSER LICENSING BOARD