Provider Demographics
NPI:1912207549
Name:STRIBLING, MINDY ROBIN (MS, SLP)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:ROBIN
Last Name:STRIBLING
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-1276
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6804 SANGER AVE
Practice Address - Street 2:#227
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4257
Practice Address - Country:US
Practice Address - Phone:800-340-4098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207164901Medicaid
TX149984001Medicaid
TX149984001Medicaid
TX676535Medicare PIN