Provider Demographics
NPI:1811238108
Name:ROBUCK, BETH (PHD,CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:ROBUCK
Suffix:
Gender:F
Credentials:PHD,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 KIMBROUGH RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3209
Mailing Address - Country:US
Mailing Address - Phone:901-751-2593
Mailing Address - Fax:901-751-2593
Practice Address - Street 1:1864 KIMBROUGH RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3209
Practice Address - Country:US
Practice Address - Phone:901-751-2593
Practice Address - Fax:901-751-2593
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000001612235Z00000X
MSS0615235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist