Provider Demographics
NPI:1508183559
Name:ROBERTS, RACHEL ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 SW BIRDIE DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1100
Mailing Address - Country:US
Mailing Address - Phone:503-807-3397
Mailing Address - Fax:
Practice Address - Street 1:111 N 20TH ST
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9535
Practice Address - Country:US
Practice Address - Phone:541-368-4313
Practice Address - Fax:541-929-4967
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist