Provider Demographics
NPI:1619153129
Name:ROBERTS, CAROL A (SLP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:GLUC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:297 LAKEFRONT BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-4325
Mailing Address - Country:US
Mailing Address - Phone:716-316-1645
Mailing Address - Fax:716-887-7272
Practice Address - Street 1:6167 W QUAKER ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2640
Practice Address - Country:US
Practice Address - Phone:716-662-4800
Practice Address - Fax:716-662-5700
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015379-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist