Provider Demographics
NPI:1720547094
Name:ZELLHOEFER, ROBIN LANE
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LANE
Last Name:ZELLHOEFER
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 1:6740 INDIAN ST
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8206
Mailing Address - Country:US
Mailing Address - Phone:850-776-9021
Mailing Address - Fax:
Practice Address - Street 1:50 JOACHIM DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4474
Practice Address - Country:US
Practice Address - Phone:800-444-6845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-17
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist