Provider Demographics
NPI:1629261144
Name:ROBERSON, ANDRIA RASHAUN (MS, CCC)
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:RASHAUN
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3483 SATELLITE BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8692
Mailing Address - Country:US
Mailing Address - Phone:770-418-1778
Mailing Address - Fax:770-418-1794
Practice Address - Street 1:3483 SATELLITE BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8692
Practice Address - Country:US
Practice Address - Phone:770-418-1778
Practice Address - Fax:770-418-1794
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006707235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist