Provider Demographics
NPI:1407412711
Name:HEITMAN, ROBIN MARIE (MA CCC-A)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:MARIE
Last Name:HEITMAN
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:MARIE
Other - Last Name:JANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-A
Mailing Address - Street 1:32 MONTROSE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3034
Mailing Address - Country:US
Mailing Address - Phone:864-380-9342
Mailing Address - Fax:
Practice Address - Street 1:29 N ACADEMY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2629
Practice Address - Country:US
Practice Address - Phone:864-331-1400
Practice Address - Fax:864-331-1416
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC877231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist