Provider Demographics
NPI:1356119804
Name:ROBERTS, MANDI MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MANDI
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MANDI
Other - Middle Name:MARIE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:18551 E 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-8519
Mailing Address - Country:US
Mailing Address - Phone:303-655-6206
Mailing Address - Fax:
Practice Address - Street 1:4949 E 147TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-8633
Practice Address - Country:US
Practice Address - Phone:303-655-6406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO304624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist