Provider Demographics
NPI:1821243841
Name:BLACK, ROBYN L (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:L
Last Name:BLACK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MONTGOMERY STREET
Mailing Address - Street 2:APARTMENT 1R
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2321
Mailing Address - Country:US
Mailing Address - Phone:201-410-8902
Mailing Address - Fax:
Practice Address - Street 1:110 MONTGOMERY ST
Practice Address - Street 2:APARTMENT 1R
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2321
Practice Address - Country:US
Practice Address - Phone:201-410-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00536400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist