Provider Demographics
NPI:1679144471
Name:WEAVER, ROBIN SUE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:SUE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S JEFFERSON PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2184
Mailing Address - Country:US
Mailing Address - Phone:971-217-3127
Mailing Address - Fax:
Practice Address - Street 1:1000 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5533
Practice Address - Country:US
Practice Address - Phone:509-222-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61185753235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14309566OtherASHA
WA61185753OtherDEPARTMENT OF HEALTH