Provider Demographics
NPI:1114044302
Name:PHILLIS, ROBERT HUSTON II (MA, CCC-A)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:HUSTON
Last Name:PHILLIS
Suffix:II
Gender:M
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1185
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-1185
Mailing Address - Country:US
Mailing Address - Phone:724-438-0981
Mailing Address - Fax:
Practice Address - Street 1:37 E FAYETTE ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-4252
Practice Address - Country:US
Practice Address - Phone:724-438-0981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT-000665-L231H00000X
OHA-01504231H00000X
WVA0048231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist