Provider Demographics
NPI:1720169774
Name:ROBINSON, MONICA JANETTE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:JANETTE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:BROADNAX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:741 KENILWORTH AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3874
Mailing Address - Country:US
Mailing Address - Phone:704-523-8027
Mailing Address - Fax:704-523-8031
Practice Address - Street 1:600 JACKSON ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5719
Practice Address - Country:US
Practice Address - Phone:540-373-3223
Practice Address - Fax:540-371-3753
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7457235Z00000X
VA2202009158235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412706Medicaid