Provider Demographics
NPI:1447385182
Name:AMENT, ROBIN PIERCE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:PIERCE
Last Name:AMENT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 AQUARIUS AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-9068
Mailing Address - Country:US
Mailing Address - Phone:970-858-8566
Mailing Address - Fax:
Practice Address - Street 1:1135 AQUARIUS AVE
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-9068
Practice Address - Country:US
Practice Address - Phone:970-858-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84239522Medicaid