Provider Demographics
NPI:1336463736
Name:KUSHNER, ROBIN (MA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:KUSHNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 OCEAN PARK BLVD
Mailing Address - Street 2:#120
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3224
Mailing Address - Country:US
Mailing Address - Phone:310-581-6430
Mailing Address - Fax:
Practice Address - Street 1:3205 OCEAN PARK BLVD
Practice Address - Street 2:#120
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3224
Practice Address - Country:US
Practice Address - Phone:310-581-6430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist