Provider Demographics
NPI:1245549922
Name:BROCKLER ROBINSON, STEPHANIE MARIE (MS, CFY-SLP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:BROCKLER ROBINSON
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:BROCKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CFY-SLP
Mailing Address - Street 1:4132 LONGHILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-6304
Mailing Address - Country:US
Mailing Address - Phone:757-645-4620
Mailing Address - Fax:
Practice Address - Street 1:4132 LONGHILL RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-6304
Practice Address - Country:US
Practice Address - Phone:757-645-4620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006161235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist