Provider Demographics
NPI:1720184567
Name:ROBINSON, KEVIN LYNN (MS-CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LYNN
Last Name:ROBINSON
Suffix:
Gender:M
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 1:4104 PRIMROSE PATH
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-6691
Mailing Address - Country:US
Mailing Address - Phone:336-995-4994
Mailing Address - Fax:336-464-2918
Practice Address - Street 1:4104 PRIMROSE PATH
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-6691
Practice Address - Country:US
Practice Address - Phone:336-995-4994
Practice Address - Fax:336-464-2918
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2971235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7472749Medicaid