Provider Demographics
NPI:1043521230
Name:REYNOLDS, ROBIN L (MA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:L
Other - Last Name:WELLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:560 W MITCHELL ST STE 250
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2277
Mailing Address - Country:US
Mailing Address - Phone:231-487-3277
Mailing Address - Fax:231-487-6167
Practice Address - Street 1:560 W MITCHELL ST STE 250
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2277
Practice Address - Country:US
Practice Address - Phone:231-487-3277
Practice Address - Fax:231-487-6167
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000274231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist