Provider Demographics
NPI:1043323264
Name:ROBINSON, VICKY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
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 1:518 RAMBLEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4340
Mailing Address - Country:US
Mailing Address - Phone:405-641-0686
Mailing Address - Fax:
Practice Address - Street 1:7301 BROADWAY EXT
Practice Address - Street 2:SUITE 115
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9045
Practice Address - Country:US
Practice Address - Phone:405-840-1335
Practice Address - Fax:405-840-1335
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK308235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist