Provider Demographics
NPI:1356351613
Name:ROBERTSON, JENNIFER E (MCD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:E
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16893 HYDRICK RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72324-8703
Mailing Address - Country:US
Mailing Address - Phone:870-588-7372
Mailing Address - Fax:870-588-4782
Practice Address - Street 1:16893 HYDRICK RD
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:AR
Practice Address - Zip Code:72324-8703
Practice Address - Country:US
Practice Address - Phone:870-588-7372
Practice Address - Fax:870-588-4782
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist