Provider Demographics
NPI:1790201549
Name:REID, ROBIN NICOLE (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:NICOLE
Last Name:REID
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 1:15511 HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-4727
Mailing Address - Country:US
Mailing Address - Phone:618-521-3608
Mailing Address - Fax:
Practice Address - Street 1:224 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3509
Practice Address - Country:US
Practice Address - Phone:618-532-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004724235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist