Provider Demographics
NPI:1093953929
Name:VAN BUREN, ROBIN LYNN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:VAN BUREN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3629 W MACARTHUR BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6844
Mailing Address - Country:US
Mailing Address - Phone:714-241-8815
Mailing Address - Fax:714-551-8817
Practice Address - Street 1:2961 W MACARTHUR BLVD
Practice Address - Street 2:127
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6913
Practice Address - Country:US
Practice Address - Phone:714-241-8815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 11954235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist