Provider Demographics
NPI:1942320973
Name:ROBERTSON, VIRGINIA RUTH (CCC, SLP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:RUTH
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 SUGAR MILL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6161
Mailing Address - Country:US
Mailing Address - Phone:704-553-2918
Mailing Address - Fax:
Practice Address - Street 1:2400 SUGAR MILL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-6161
Practice Address - Country:US
Practice Address - Phone:704-553-2918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist