Provider Demographics
NPI:1598224347
Name:ROBINSON, SHANNON LARAE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LARAE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N RICE AVE STE 170180
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7912
Mailing Address - Country:US
Mailing Address - Phone:805-826-9000
Mailing Address - Fax:
Practice Address - Street 1:1901 N RICE AVE STE 170180
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7912
Practice Address - Country:US
Practice Address - Phone:805-826-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty