Provider Demographics
NPI:1538408455
Name:HAYCOOK, ROBYN (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:
Last Name:HAYCOOK
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:398 S GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5549
Mailing Address - Country:US
Mailing Address - Phone:614-716-0892
Mailing Address - Fax:614-716-0902
Practice Address - Street 1:398 S GRANT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5549
Practice Address - Country:US
Practice Address - Phone:614-716-0892
Practice Address - Fax:614-716-0902
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI07000781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH13281Medicaid