Provider Demographics
NPI:1881807964
Name:WURST, ROBIN B (SLP)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:B
Last Name:WURST
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 1:455 N WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-2562
Mailing Address - Country:US
Mailing Address - Phone:928-425-8934
Mailing Address - Fax:928-425-8936
Practice Address - Street 1:455 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-2562
Practice Address - Country:US
Practice Address - Phone:928-425-8934
Practice Address - Fax:928-425-8936
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL0331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ769929OtherAHCCCS