Provider Demographics
NPI:1023316965
Name:ROBINSON, MYRIAM K (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MYRIAM
Middle Name:K
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5190 ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-4248
Mailing Address - Country:US
Mailing Address - Phone:404-643-6098
Mailing Address - Fax:877-245-3717
Practice Address - Street 1:5190 ISLAND DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-4248
Practice Address - Country:US
Practice Address - Phone:404-643-6098
Practice Address - Fax:877-245-3717
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist