Provider Demographics
NPI:1457526683
Name:ROBERTS, STEPHENIE FORD (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHENIE
Middle Name:FORD
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 1:22404 NE STATE ROAD 20
Mailing Address - Street 2:
Mailing Address - City:HOSFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32334-2406
Mailing Address - Country:US
Mailing Address - Phone:850-445-1288
Mailing Address - Fax:
Practice Address - Street 1:22404 NE STATE ROAD 20
Practice Address - Street 2:
Practice Address - City:HOSFORD
Practice Address - State:FL
Practice Address - Zip Code:32334-2406
Practice Address - Country:US
Practice Address - Phone:850-445-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist