Provider Demographics
NPI:1316394190
Name:ROBINSON, JANAE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:
Last Name:ROBINSON
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:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:NM
Mailing Address - Zip Code:87743-0162
Mailing Address - Country:US
Mailing Address - Phone:806-341-6590
Mailing Address - Fax:
Practice Address - Street 1:525 ROOSEVELT STREET
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:NM
Practice Address - Zip Code:87743
Practice Address - Country:US
Practice Address - Phone:806-341-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109513235Z00000X
NMSAH-2023-0071235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist