Provider Demographics
NPI:1811488919
Name:WETHERINGTON, ROBIN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:WETHERINGTON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 JOE MCINTOSH RD
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33565-7456
Mailing Address - Country:US
Mailing Address - Phone:813-763-5199
Mailing Address - Fax:
Practice Address - Street 1:1495 JOE MCINTOSH RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33565-7456
Practice Address - Country:US
Practice Address - Phone:813-763-5199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist