Provider Demographics
NPI:1497982664
Name:ROBERTS, MINDY (SLP)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MINDAY
Other - Middle Name:
Other - Last Name:UDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:PO BOX 5285
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5285
Mailing Address - Country:US
Mailing Address - Phone:308-382-0344
Mailing Address - Fax:308-382-3241
Practice Address - Street 1:3601 CIMARRON PLZ
Practice Address - Street 2:SUITE 105
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2884
Practice Address - Country:US
Practice Address - Phone:402-463-2077
Practice Address - Fax:402-463-2062
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1323235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist