Provider Demographics
NPI:1144647694
Name:WILHELMI TRUSTY, ROBIN CHANDRA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:CHANDRA
Last Name:WILHELMI TRUSTY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SAINT PETER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4905
Mailing Address - Country:US
Mailing Address - Phone:207-272-4933
Mailing Address - Fax:
Practice Address - Street 1:19 SAINT PETER ST APT 2
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4905
Practice Address - Country:US
Practice Address - Phone:207-272-4933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-22
Last Update Date:2014-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8976235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist