Provider Demographics
NPI:1568601318
Name:ROBERTS, HEIDII I (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:HEIDII
Middle Name:I
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13950 SE 114TH CT
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8518
Mailing Address - Country:US
Mailing Address - Phone:503-550-3787
Mailing Address - Fax:503-698-8096
Practice Address - Street 1:2305 SE WASHINGTON ST STE 102
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7647
Practice Address - Country:US
Practice Address - Phone:503-550-3787
Practice Address - Fax:503-654-1014
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500656249Medicaid