Provider Demographics
NPI:1356093660
Name:ROBBINS, IVY
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:ROBBINS
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 1:2106 S TATE ST STE E
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-7913
Mailing Address - Country:US
Mailing Address - Phone:662-643-4043
Mailing Address - Fax:662-643-4044
Practice Address - Street 1:2106 S TATE ST STE E
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-7913
Practice Address - Country:US
Practice Address - Phone:662-643-4043
Practice Address - Fax:662-643-4044
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS4716235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist