Provider Demographics
NPI:1558515155
Name:ROBERSON, DEBORAH GAYE (SLP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:GAYE
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 MALVERN RD
Mailing Address - Street 2:
Mailing Address - City:CADDO VALLEY
Mailing Address - State:AR
Mailing Address - Zip Code:71923-9629
Mailing Address - Country:US
Mailing Address - Phone:870-246-3898
Mailing Address - Fax:
Practice Address - Street 1:762 MARTIN ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AR
Practice Address - Zip Code:71857-2749
Practice Address - Country:US
Practice Address - Phone:870-887-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist