Provider Demographics
NPI:1114773207
Name:RIVARD, ROBIN
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:RIVARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 E MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:BARRON
Mailing Address - State:WI
Mailing Address - Zip Code:54812-1479
Mailing Address - Country:US
Mailing Address - Phone:715-537-6164
Mailing Address - Fax:715-537-6274
Practice Address - Street 1:335 E MONROE AVE
Practice Address - Street 2:
Practice Address - City:BARRON
Practice Address - State:WI
Practice Address - Zip Code:54812-1479
Practice Address - Country:US
Practice Address - Phone:715-537-6164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI215571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist