Provider Demographics
NPI:1598901415
Name:JOHNSTON, ROBIN L (MSP-CCC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MSP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:MS
Mailing Address - Zip Code:39119-1107
Mailing Address - Country:US
Mailing Address - Phone:601-797-3405
Mailing Address - Fax:601-797-9842
Practice Address - Street 1:603 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:MS
Practice Address - Zip Code:39119-8902
Practice Address - Country:US
Practice Address - Phone:601-797-3405
Practice Address - Fax:601-797-9842
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0535235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist