Provider Demographics
NPI:1396052320
Name:ROBERSON, LAUREN MICHELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHELLE
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:MICHELLE
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:6830 CENTRAL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1208
Mailing Address - Country:US
Mailing Address - Phone:727-823-2529
Mailing Address - Fax:727-823-2529
Practice Address - Street 1:6830 CENTRAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1208
Practice Address - Country:US
Practice Address - Phone:727-823-2529
Practice Address - Fax:727-823-2529
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist