MEDICARE: MS. LATERRIAN MARIE ROBINSON M.S., 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	SLP007761	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063778710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LATERRIAN MARIE ROBINSON M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	115 BOWEN WAY
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30016-3434
Country	:	US
Telephone Number	:	205-602-2337
Fax Number	:

Provider Business Practice Location Address
First Line	:	2395 WALL ST SE
Second Line	:	STE 170
City	:	CONYERS
State	:	GA
Zip	:	30013-6703
Country	:	US
Telephone Number	:	205-602-2337
Fax Number	:

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

Provider Enumeration Date	:	04/06/2012
Last Update Date	:	08/25/2016

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Directions to “ MS. LATERRIAN MARIE ROBINSON M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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