Individual provider Active NPI

Kelly Elizabeth Robertson, M.S., SLP

  • Speech-Language Pathologist
  • Bedford, VA
National Provider Identifier
1487216875
Registry record updated Jul 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
2204000298 Issued in VA
Practice address
1229 County Farm Rd
Bedford, VA 24523-3131
Phone
(540) 586-7658
NPI assigned
Jul 5, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 2204000298 VA Primary

Addresses

Primary practice location

1229 County Farm Rd
Bedford, VA 24523-3131

Mailing address

334 Lakeview Dr
Roanoke, VA 24012-9064
Phone (540) 797-7119

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
2204000298VAMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1562284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562284800000",
    "number": "1487216875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "334 LAKEVIEW DR",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240129064",
            "telephone_number": "540-797-7119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1229 COUNTY FARM RD",
            "city": "BEDFORD",
            "state": "VA",
            "postal_code": "245233131",
            "telephone_number": "540-586-7658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "KELLY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "M.S., SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-05",
        "last_updated": "2019-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2204000298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bedford, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2019; 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.