Provider Demographics
NPI:1205094794
Name:FISHER, ROBIN LYNNE (MS/CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:LYNNE
Last Name:FISHER
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 1:855 GIANT OAK RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2897
Mailing Address - Country:US
Mailing Address - Phone:863-802-0099
Mailing Address - Fax:
Practice Address - Street 1:855 GIANT OAK RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2897
Practice Address - Country:US
Practice Address - Phone:863-802-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6600235Z00000X
PASL004901L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist