Provider Demographics
NPI:1225480940
Name:MEYER ROBERTS, KIM (MA,CCC SLP)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:MEYER 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 1:1119 WOODRIVER DR
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-5224
Mailing Address - Country:US
Mailing Address - Phone:605-280-1770
Mailing Address - Fax:
Practice Address - Street 1:211 S POPLAR AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-1845
Practice Address - Country:US
Practice Address - Phone:605-773-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD130-SLP235Z00000X
SD01020705 ASHA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist