Provider Demographics
NPI:1538296108
Name:WEISS, ROBIN LYNCH (MS)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:LYNCH
Last Name:WEISS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CHOCTAW TRL
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4304
Mailing Address - Country:US
Mailing Address - Phone:386-673-1084
Mailing Address - Fax:
Practice Address - Street 1:9 CHOCTAW TRAIL
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4304
Practice Address - Country:US
Practice Address - Phone:386-673-1084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8877947Medicaid