Provider Demographics
NPI:1609862432
Name:KORNFIELD, ROBERTA T (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:T
Last Name:KORNFIELD
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5989 MEADOW LARK LN
Mailing Address - Street 2:
Mailing Address - City:EAST PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520-1400
Mailing Address - Country:US
Mailing Address - Phone:717-560-0441
Mailing Address - Fax:717-560-0441
Practice Address - Street 1:2215 DUTCH GOLD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1940
Practice Address - Country:US
Practice Address - Phone:717-569-8972
Practice Address - Fax:717-569-7762
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000183L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019256200003Medicaid