Provider Demographics
NPI:1457083115
Name:BIELITZ, ROBERTA ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:ANN
Last Name:BIELITZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:ANN
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2817 GAYLE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-6219
Mailing Address - Country:US
Mailing Address - Phone:972-977-9290
Mailing Address - Fax:
Practice Address - Street 1:2301 SAM HOUSTON DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-7507
Practice Address - Country:US
Practice Address - Phone:972-375-3020
Practice Address - Fax:972-675-3025
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108007235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist