Provider Demographics
NPI:1730425133
Name:HUTSON, ROBIN (BC-HIS)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:HUTSON
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 LAKE MURRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063
Mailing Address - Country:US
Mailing Address - Phone:803-603-2501
Mailing Address - Fax:803-749-6017
Practice Address - Street 1:1060 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063
Practice Address - Country:US
Practice Address - Phone:803-749-6017
Practice Address - Fax:803-749-6017
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHAS-0405237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist