Provider Demographics
NPI:1407026982
Name:ROSEN, ROBIN L (MA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:ROSEN
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 1:656 COLEMAN BLVD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4063
Mailing Address - Country:US
Mailing Address - Phone:610-909-7186
Mailing Address - Fax:
Practice Address - Street 1:656 COLEMAN BLVD UNIT 104
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4063
Practice Address - Country:US
Practice Address - Phone:610-909-7186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000154L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist