Provider Demographics
NPI:1730960519
Name:ROBINSON, LEGACY GRACE (CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:LEGACY
Middle Name:GRACE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:LEGACY
Other - Middle Name:GRACE
Other - Last Name:HUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 W FITE ST
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-3711
Mailing Address - Country:US
Mailing Address - Phone:573-431-2616
Mailing Address - Fax:
Practice Address - Street 1:403 W FITE ST
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-3711
Practice Address - Country:US
Practice Address - Phone:573-431-2616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023012393235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist