MEDICARE: MYRIAM K ROBINSON CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	005420	GA

General Provider Information

NPI Number	:	1023316965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRIAM K ROBINSON CCC-SLP

Provider Business Mailing Address
First Line	:	5190 ISLAND DR
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-4248
Country	:	US
Telephone Number	:	404-643-6098
Fax Number	:	877-245-3717

Provider Business Practice Location Address
First Line	:	5190 ISLAND DR
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-4248
Country	:	US
Telephone Number	:	404-643-6098
Fax Number	:	877-245-3717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2011
Last Update Date	:	06/25/2012

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Directions to “ MYRIAM K ROBINSON CCC-SLP” Practice Location

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