Provider Demographics
NPI:1023525714
Name:MAISE, ROBIN GRACE (MCD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:GRACE
Last Name:MAISE
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:GRACE
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD, CCC-SLP
Mailing Address - Street 1:2075 MAX LUTHER DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-3859
Mailing Address - Country:US
Mailing Address - Phone:256-852-5600
Mailing Address - Fax:256-852-6722
Practice Address - Street 1:2075 MAX LUTHER DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-3859
Practice Address - Country:US
Practice Address - Phone:256-852-5600
Practice Address - Fax:256-852-6722
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist