Provider Demographics
NPI:1821279910
Name:HAMPTON, ROBERT CHARLES (SLP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N JOHNSON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-3962
Mailing Address - Country:US
Mailing Address - Phone:903-573-3540
Mailing Address - Fax:888-567-4527
Practice Address - Street 1:315 N JOHNSON AVE STE 102
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-3962
Practice Address - Country:US
Practice Address - Phone:903-573-3540
Practice Address - Fax:888-567-4527
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-17
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101374235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195520502Medicaid
TX195520502Medicaid