Provider Demographics
NPI:1700836194
Name:ROBERTS, CHARLA (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHARLA
Middle Name:
Last Name:ROBERTS
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 1:349 PIPPIN APPLE CIR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-9741
Mailing Address - Country:US
Mailing Address - Phone:479-756-2024
Mailing Address - Fax:
Practice Address - Street 1:922 E EMMA AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4503
Practice Address - Country:US
Practice Address - Phone:479-756-2024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist