Provider Demographics
NPI:1154431302
Name:ROBINSON, WANDA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:ROBINSON
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 1:560 IVORY RD SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3054
Mailing Address - Country:US
Mailing Address - Phone:505-720-6111
Mailing Address - Fax:505-896-4866
Practice Address - Street 1:560 IVORY RD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3054
Practice Address - Country:US
Practice Address - Phone:505-720-6111
Practice Address - Fax:505-896-4866
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist