Provider Demographics
NPI:1083959100
Name:DOUGLASS, ROBIN F (SLP)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:F
Last Name:DOUGLASS
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 1:25077 MAIDSTONE LN
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1770
Mailing Address - Country:US
Mailing Address - Phone:216-374-5154
Mailing Address - Fax:
Practice Address - Street 1:25077 MAIDSTONE LN
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1770
Practice Address - Country:US
Practice Address - Phone:216-374-5154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-3226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist