Provider Demographics
NPI:1366407298
Name:ROBINSON, REBECCA (SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 115TH LN N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9220 BASS LAKE RD
Practice Address - Street 2:SUITE 260
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-3000
Practice Address - Country:US
Practice Address - Phone:763-533-0363
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist