Provider Demographics
NPI:1336774660
Name:STAFFORD, ROBIN S (HIS)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:S
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20342 CRESCENT MDWS
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-5183
Mailing Address - Country:US
Mailing Address - Phone:985-974-6681
Mailing Address - Fax:
Practice Address - Street 1:1809 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-3619
Practice Address - Country:US
Practice Address - Phone:985-974-6681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist