Provider Demographics
NPI:1366993610
Name:ROBERSON, ERICA VERONIQUE
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:VERONIQUE
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14409 GREENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3293
Mailing Address - Country:US
Mailing Address - Phone:301-498-8100
Mailing Address - Fax:
Practice Address - Street 1:14409 GREENVIEW DR
Practice Address - Street 2:# 102
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3293
Practice Address - Country:US
Practice Address - Phone:301-498-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08110235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist