Provider Demographics
NPI:1730239070
Name:SIMPSON, ROBERTA JEAN (MA)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:JEAN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 PIANO AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4979
Mailing Address - Country:US
Mailing Address - Phone:928-729-8793
Mailing Address - Fax:
Practice Address - Street 1:FORT DEFIANCE INDIAN HOSPITAL
Practice Address - Street 2:CORNER OF ROUTE N12 AND N7
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAO1150231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist