Provider Demographics
NPI:1801998281
Name:ROBINSON, CHARLENE ELAINE (SLP)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:ELAINE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6837 NW 110TH WAY
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3836
Mailing Address - Country:US
Mailing Address - Phone:954-796-7669
Mailing Address - Fax:
Practice Address - Street 1:6837 NW 110TH WAY
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-3836
Practice Address - Country:US
Practice Address - Phone:954-796-7669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2235235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist