Provider Demographics
NPI:1942598875
Name:RODRIGUEZ-HIGGINBOTTOM, ROBIN (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:RODRIGUEZ-HIGGINBOTTOM
Suffix:
Gender:F
Credentials:MS,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:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74477-0232
Mailing Address - Country:US
Mailing Address - Phone:918-485-5998
Mailing Address - Fax:918-201-7015
Practice Address - Street 1:215 E CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467
Practice Address - Country:US
Practice Address - Phone:918-485-5998
Practice Address - Fax:918-201-7015
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3241235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200343320AMedicaid
OK200632630BMedicaid