Provider Demographics
NPI:1386762516
Name:DREW, ROBERT PAUL (AUD, MS, CCC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:DREW
Suffix:
Gender:M
Credentials:AUD, MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 SANTA FE SPGS
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-6214
Mailing Address - Country:US
Mailing Address - Phone:928-713-7295
Mailing Address - Fax:
Practice Address - Street 1:2136 SANTA FE SPGS
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-6214
Practice Address - Country:US
Practice Address - Phone:928-713-7295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105448231HA2500X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ833435OtherAHCCCS