Provider Demographics
NPI:1639468804
Name:WEIDLER, ROBYN DAVIS (MED,CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:DAVIS
Last Name:WEIDLER
Suffix:
Gender:F
Credentials:MED,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 SIDNEY LANIER AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-6549
Mailing Address - Country:US
Mailing Address - Phone:478-230-1578
Mailing Address - Fax:
Practice Address - Street 1:221 SIDNEY LANIER AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-6549
Practice Address - Country:US
Practice Address - Phone:478-230-1578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007369235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist