Provider Demographics
NPI:1518262195
Name:ROBIN, PEGGY J (SLP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:J
Last Name:ROBIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16963 BOSQUE DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3532
Mailing Address - Country:US
Mailing Address - Phone:818-784-5033
Mailing Address - Fax:
Practice Address - Street 1:16963 BOSQUE DR
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3532
Practice Address - Country:US
Practice Address - Phone:818-784-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3093235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist