Provider Demographics
NPI:1679273726
Name:ROBERTSON, KEYONA DION TERRY (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KEYONA
Middle Name:DION TERRY
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 ROBIN REED CT
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-8852
Mailing Address - Country:US
Mailing Address - Phone:704-241-4372
Mailing Address - Fax:
Practice Address - Street 1:410 ROBIN REED CT
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-8852
Practice Address - Country:US
Practice Address - Phone:704-241-4372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8833235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist