Provider Demographics
NPI:1033435417
Name:DAVIS, ROBIN A (SLP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CHARON TER
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-2102
Mailing Address - Country:US
Mailing Address - Phone:413-534-7974
Mailing Address - Fax:
Practice Address - Street 1:439 GRANBY RD STE 1
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-2213
Practice Address - Country:US
Practice Address - Phone:413-575-8682
Practice Address - Fax:413-322-8061
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-11
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4826235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist