Provider Demographics
NPI:1134430101
Name:ROBSON, JAMELA BORNE
Entity type:Individual
Prefix:
First Name:JAMELA
Middle Name:BORNE
Last Name:ROBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 POMEROY AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-5922
Mailing Address - Country:US
Mailing Address - Phone:904-414-6267
Mailing Address - Fax:
Practice Address - Street 1:121 POMEROY AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-5922
Practice Address - Country:US
Practice Address - Phone:904-414-6267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010221235Z00000X
IL146.010221235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist