Provider Demographics
NPI:1578813432
Name:PLUMMER, ROBERTA MARLENE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:MARLENE
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:MARLENE
Other - Last Name:EERNISSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1286 S BARNES DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8632
Mailing Address - Country:US
Mailing Address - Phone:812-272-0988
Mailing Address - Fax:
Practice Address - Street 1:1286 S BARNES DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8632
Practice Address - Country:US
Practice Address - Phone:812-272-0988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004272A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist