Provider Demographics
NPI:1104215094
Name:RUZIC, ROBIN MOORE
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:MOORE
Last Name:RUZIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N RIVERSHIRE DR
Mailing Address - Street 2:#210
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-0001
Mailing Address - Country:US
Mailing Address - Phone:936-494-0570
Mailing Address - Fax:
Practice Address - Street 1:333 N RIVERSHIRE DR
Practice Address - Street 2:#210
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-0001
Practice Address - Country:US
Practice Address - Phone:936-494-0570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108084235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist