Provider Demographics
NPI:1649657339
Name:ROBINSON, DERRICK (MA SLP CCC)
Entity type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MA SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 MAIN ST # 1268
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-3470
Mailing Address - Country:US
Mailing Address - Phone:513-410-5582
Mailing Address - Fax:513-270-2682
Practice Address - Street 1:6809 MAIN ST # 1268
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-3470
Practice Address - Country:US
Practice Address - Phone:513-410-5582
Practice Address - Fax:513-270-2682
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.11174235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist