Provider Demographics
NPI:1184964561
Name:ROBBINS, DIANE K (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 CLARK LANE
Mailing Address - Street 2:
Mailing Address - City:STAR VALLEY RANCH
Mailing Address - State:WY
Mailing Address - Zip Code:83127-7004
Mailing Address - Country:US
Mailing Address - Phone:307-883-0350
Mailing Address - Fax:
Practice Address - Street 1:HC 62 BOX 7388
Practice Address - Street 2:
Practice Address - City:STAR VALLEY RANCH
Practice Address - State:WY
Practice Address - Zip Code:83127-7004
Practice Address - Country:US
Practice Address - Phone:307-883-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-567235Z00000X
IDSLP-1980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist