Provider Demographics
NPI:1588618375
Name:VANCE, ROBIN TIERNAN (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:TIERNAN
Last Name:VANCE
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 JOCASSEE TRCE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7357
Mailing Address - Country:US
Mailing Address - Phone:803-957-7132
Mailing Address - Fax:
Practice Address - Street 1:127 JOCASSEE TRCE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7357
Practice Address - Country:US
Practice Address - Phone:803-957-7132
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3537235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0661Medicaid