Khanedra Edwards Roberts, MS,CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

22003661A Issued in IN

Practice address

2812 Cumberland Dr Apt 1G
Valparaiso, IN 46383-2532

Phone

(219) 331-9514

NPI assigned

Jan 14, 2007

Last updated

Mar 31, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Simply Speaking Inc.

  • Early Intervention Provider Agency
  • Valparaiso, IN
  • NPI 1043541931
  Authorized official Same address or phone
• Khanedra Z Edwards

  • Speech-Language Pathologist
  • Gary, IN
  • NPI 1457492431
  NPD (past)
• Next Level Therapeutic Services LLP

  • Physical Therapist
  • Gary, IN
  • NPI 1609068808
  NPD (past)
• Restore Therapy Services LLC

  • Occupational Therapist
  • Gary, IN
  • NPI 1932494424
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585612800000",
    "number": "1467503896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 812",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463680812",
            "telephone_number": "219-331-9514",
            "fax_number": "219-939-0020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2812 CUMBERLAND DR APT 1G",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832532",
            "telephone_number": "219-331-9514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "KHANEDRA",
        "middle_name": "EDWARDS",
        "name_prefix": "Ms.",
        "credential": "MS,CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-14",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IN",
            "license": "22003661A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200340020A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPEECH PATHOLOGIST",
            "identifier": "200726320",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan L Rizer, LCSW
• Michael P Roach, O.D.
• Dorthea L Robbins, LCSW
• Candace Brittany Roberson
• Robert L Brunk II DO PC
• Josh Robertson, LCSW
• Angelle Robinson
• Dana R Robinson, P.T.
• Diamond Robinson, BEHAVIOR TECHNICIAN
• Joyce Anne Robinson, RPH

• Speech-Language Pathologist in Valparaiso, IN
• Providers in Valparaiso, IN by specialty
• Speech-Language Pathologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.