Provider Demographics
NPI:1699809186
Name:ROSSMAN, ROBIN (MA CCC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:ROSSMAN
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 BOHEMIAN HWY
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-9579
Mailing Address - Country:US
Mailing Address - Phone:707-874-2897
Mailing Address - Fax:
Practice Address - Street 1:30 N SAN PEDRO RD
Practice Address - Street 2:SUITE 265
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4118
Practice Address - Country:US
Practice Address - Phone:415-479-7880
Practice Address - Fax:415-479-7889
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist