Provider Demographics
NPI:1669538872
Name:ROBINSON, KELLY LARUE (MED CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LARUE
Last Name:ROBINSON
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 1:3217 SUMMER STREAM LN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-5883
Mailing Address - Country:US
Mailing Address - Phone:404-446-6196
Mailing Address - Fax:678-354-5521
Practice Address - Street 1:3217 SUMMER STREAM LN NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-5883
Practice Address - Country:US
Practice Address - Phone:404-446-6196
Practice Address - Fax:678-354-5521
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist