Provider Demographics
NPI:1649643990
Name:ROBERTSON, CARMEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:ROBERTSON
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 1:366 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:KY
Mailing Address - Zip Code:42031-1324
Mailing Address - Country:US
Mailing Address - Phone:270-653-2461
Mailing Address - Fax:
Practice Address - Street 1:366 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:KY
Practice Address - Zip Code:42031-1324
Practice Address - Country:US
Practice Address - Phone:270-653-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3062235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist