Provider Demographics
NPI:1851608434
Name:COREY, ROBIN L (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:COREY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BELFAST RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:ME
Mailing Address - Zip Code:04910-6318
Mailing Address - Country:US
Mailing Address - Phone:207-437-2522
Mailing Address - Fax:
Practice Address - Street 1:25 MESSALONSKEE AVE
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5206
Practice Address - Country:US
Practice Address - Phone:207-872-4281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1225235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME611592446Medicaid