Provider Demographics
NPI:1407117583
Name:ROBERTS, JENNAFER
Entity Type:Individual
Prefix:
First Name:JENNAFER
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39763 SOUTH DIAMOND BAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739
Mailing Address - Country:US
Mailing Address - Phone:218-341-5857
Mailing Address - Fax:
Practice Address - Street 1:1200 N EL DORADO PLACE
Practice Address - Street 2:STE A150
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85751
Practice Address - Country:US
Practice Address - Phone:520-298-7883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ77342355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant