Provider Demographics
NPI:1962721035
Name:HOVERMALE, ROBIN LADONNA (MS SLP CCC)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:LADONNA
Last Name:HOVERMALE
Suffix:
Gender:F
Credentials:MS SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 TUT RD
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-2821
Mailing Address - Country:US
Mailing Address - Phone:228-217-7390
Mailing Address - Fax:
Practice Address - Street 1:11975 SEAWAY RD STE A226
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-6250
Practice Address - Country:US
Practice Address - Phone:228-896-2824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2210235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist