Provider Demographics
NPI:1619253150
Name:ROBERTSON, KAREN K (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:K
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:IL
Mailing Address - Zip Code:62088-1229
Mailing Address - Country:US
Mailing Address - Phone:613-635-2793
Mailing Address - Fax:618-635-4637
Practice Address - Street 1:204 E LEONARD ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:IL
Practice Address - Zip Code:62088-1229
Practice Address - Country:US
Practice Address - Phone:613-635-2793
Practice Address - Fax:618-635-4637
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist