Provider Demographics
NPI:1912044850
Name:RUNBECK, ROBYN G (MSPA, EDD)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:G
Last Name:RUNBECK
Suffix:
Gender:F
Credentials:MSPA, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5262 E FANFOL DR
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1624
Mailing Address - Country:US
Mailing Address - Phone:480-951-4153
Mailing Address - Fax:
Practice Address - Street 1:11256 N 128TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-4412
Practice Address - Country:US
Practice Address - Phone:480-484-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ625717Medicaid