Provider Demographics
NPI:1669588570
Name:ROBERTS, KRISTA LEE (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:LEE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MA,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:PO BOX 294324
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029
Mailing Address - Country:US
Mailing Address - Phone:830-257-1108
Mailing Address - Fax:830-257-1137
Practice Address - Street 1:306 WESLEY DR
Practice Address - Street 2:SUITE A
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028
Practice Address - Country:US
Practice Address - Phone:830-257-1108
Practice Address - Fax:830-257-1137
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155438802Medicaid