Provider Demographics
NPI:1376727883
Name:ROBINSON, BRIDGET MALOY (MA)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:MALOY
Last Name:ROBINSON
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 1:195 GOLDEN BEAR DR
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:WV
Mailing Address - Zip Code:26047-1672
Mailing Address - Country:US
Mailing Address - Phone:304-564-3411
Mailing Address - Fax:304-564-3990
Practice Address - Street 1:195 GOLDEN BEAR DR
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:WV
Practice Address - Zip Code:26047-1672
Practice Address - Country:US
Practice Address - Phone:304-564-3411
Practice Address - Fax:304-564-3990
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810008547Medicaid