Provider Demographics
NPI:1437696598
Name:LYON, ROBIN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:LYON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6712 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1352
Mailing Address - Country:US
Mailing Address - Phone:913-375-0048
Mailing Address - Fax:
Practice Address - Street 1:6712 LOCUST ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1352
Practice Address - Country:US
Practice Address - Phone:913-375-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016033043235Z00000X
KS330235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist