Provider Demographics
NPI:1902137144
Name:ROBINSON, KELLYANN MIKRIWY (PHD)
Entity Type:Individual
Prefix:
First Name:KELLYANN
Middle Name:MIKRIWY
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2711
Mailing Address - Country:US
Mailing Address - Phone:508-523-7918
Mailing Address - Fax:
Practice Address - Street 1:159 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2711
Practice Address - Country:US
Practice Address - Phone:508-523-7918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3136235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist