Provider Demographics
NPI:1740085323
Name:HOUSEHOLDER, ROBYN RENEE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:RENEE
Last Name:HOUSEHOLDER
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8712 WINTERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8802
Mailing Address - Country:US
Mailing Address - Phone:517-282-2981
Mailing Address - Fax:
Practice Address - Street 1:8712 WINTERGREEN ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8802
Practice Address - Country:US
Practice Address - Phone:517-282-2981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty