Provider Demographics
NPI:1538102280
Name:KING, ROBERT STEPHEN (SLP)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STEPHEN
Last Name:KING
Suffix:
Gender:M
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:VA MEDICAL CENTER
Mailing Address - Street 2:BLDG 204 ROOM 071
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37684
Mailing Address - Country:US
Mailing Address - Phone:423-979-2747
Mailing Address - Fax:423-979-3404
Practice Address - Street 1:VA MEDICAL CENTER
Practice Address - Street 2:BLDG 204 ROOM 071
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-979-2747
Practice Address - Fax:423-979-3404
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist