Provider Demographics
NPI:1528267754
Name:RUSH, ROBIN SMITH (SLP)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:SMITH
Last Name:RUSH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2662 RUNYON CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5222
Mailing Address - Country:US
Mailing Address - Phone:407-438-6427
Mailing Address - Fax:407-539-2488
Practice Address - Street 1:630 N MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4423
Practice Address - Country:US
Practice Address - Phone:407-539-2488
Practice Address - Fax:407-539-2408
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8621235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist