Healthcare Provider Details

I. General information

NPI: 1114351442
Provider Name (Legal Business Name): ROBYNN WINONA WARREN M.S, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 CUSTER RD
RICHARDSON TX
75080-5623
US

IV. Provider business mailing address

320 CUSTER RD
RICHARDSON TX
75080-5623
US

V. Phone/Fax

Practice location:
  • Phone: 972-490-9055
  • Fax: 972-490-9058
Mailing address:
  • Phone: 972-490-9055
  • Fax: 972-490-9058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number108079
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: