Provider Demographics
NPI:1114168598
Name:ANDERSON, ROBIN JEAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:JEAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MEADOWBROOK COURT
Mailing Address - Street 2:APT. D
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084
Mailing Address - Country:US
Mailing Address - Phone:518-505-4803
Mailing Address - Fax:
Practice Address - Street 1:26 MEADOWBROOK APT D
Practice Address - Street 2:
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084-5708
Practice Address - Country:US
Practice Address - Phone:518-505-4803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist