Provider Demographics
NPI:1891147815
Name:RANDALL, ROBYN
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:RANDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:SD
Mailing Address - Zip Code:57058-8823
Mailing Address - Country:US
Mailing Address - Phone:605-425-2264
Mailing Address - Fax:
Practice Address - Street 1:200 E ESSEX AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:SD
Practice Address - Zip Code:57058-8823
Practice Address - Country:US
Practice Address - Phone:605-425-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-02
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist