Provider Demographics
NPI:1972619963
Name:BULLER, ROBIN BRITTNEY (MSCCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:BRITTNEY
Last Name:BULLER
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:MRS
Other - First Name:BRITTNEY
Other - Middle Name:
Other - Last Name:BULLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:10424 N IMO RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-2105
Mailing Address - Country:US
Mailing Address - Phone:580-747-1406
Mailing Address - Fax:
Practice Address - Street 1:10424 N IMO RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-2105
Practice Address - Country:US
Practice Address - Phone:580-747-1406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2022-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100638230BMedicaid