Provider Demographics
NPI:1679237093
Name:ROBERTS, RYAN RAY (SLP)
Entity Type:Individual
Prefix:MRS
First Name:RYAN
Middle Name:RAY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 PEARL ST BLDG C
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6120
Mailing Address - Country:US
Mailing Address - Phone:972-968-5800
Mailing Address - Fax:
Practice Address - Street 1:1820 PEARL ST BLDG C
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6120
Practice Address - Country:US
Practice Address - Phone:972-968-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist