MEDICARE: MS. STACEY C. ROBINSON M.E.D., 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	3965	NC

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	:	1164557096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACEY C. ROBINSON M.E.D., CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 680971
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-0017
Country	:	US
Telephone Number	:	704-264-9296
Fax Number	:

Provider Business Practice Location Address
First Line	:	8511 DAVIS LAKE PKWY
Second Line	:	SUITE C6-175
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-0536
Country	:	US
Telephone Number	:	704-264-9296
Fax Number	:

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/09/2007

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