Provider Demographics
NPI:1518267905
Name:ROBERTSON, KELLI ST CLAIR (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ST CLAIR
Last Name:ROBERTSON
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 1:209 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-2011
Mailing Address - Country:US
Mailing Address - Phone:940-206-9009
Mailing Address - Fax:
Practice Address - Street 1:209 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-2011
Practice Address - Country:US
Practice Address - Phone:940-206-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104448235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist