Provider Demographics
NPI:1538703426
Name:ROBERTS, ELIZABETH WINN (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WINN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MONCURE
Other - Last Name:WINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSP, CCC-SLP
Mailing Address - Street 1:335 DOGGETT ST APT 313
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6415
Mailing Address - Country:US
Mailing Address - Phone:434-294-2386
Mailing Address - Fax:
Practice Address - Street 1:5939 REDDMAN RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-1654
Practice Address - Country:US
Practice Address - Phone:434-294-2386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6713235Z00000X
NC13766235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist