Provider Demographics
NPI:1437436334
Name:ROBERSON, SIBYL E (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SIBYL
Middle Name:E
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:SIBYL
Other - Middle Name:E
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1315 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-4446
Mailing Address - Country:US
Mailing Address - Phone:740-502-7702
Mailing Address - Fax:
Practice Address - Street 1:1315 WALNUT ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-4446
Practice Address - Country:US
Practice Address - Phone:903-794-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107411235Z00000X
AR3410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR191316721Medicaid
TX81S770OtherTEXAS BLUE CROSS BLUE SHIELD