Healthcare Provider Details

I. General information

NPI: 1659111565
Provider Name (Legal Business Name): TORREY ROBINSON CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4607 LINDBERGH DR
JACKSON MS
39209-3855
US

IV. Provider business mailing address

110 CHARTRES DR
MADISON MS
39110-7055
US

V. Phone/Fax

Practice location:
  • Phone: 601-203-6378
  • Fax:
Mailing address:
  • Phone: 601-608-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS-5067
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: