Provider Demographics
NPI:1538827191
Name:ROBERTSON, MARYBETH F (SLP-CCC MS)
Entity type:Individual
Prefix:
First Name:MARYBETH
Middle Name:F
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:SLP-CCC MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 MEADOWLARK RD
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-2305
Mailing Address - Country:US
Mailing Address - Phone:801-369-3583
Mailing Address - Fax:
Practice Address - Street 1:345 E GATEWAY DR STE 150
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-4625
Practice Address - Country:US
Practice Address - Phone:801-494-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10775121-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist