Provider Demographics
NPI:1780741504
Name:ROBINSON, SHANTEL JOY (SLP)
Entity type:Individual
Prefix:MRS
First Name:SHANTEL
Middle Name:JOY
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 S ODEN DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-9760
Mailing Address - Country:US
Mailing Address - Phone:317-462-1368
Mailing Address - Fax:317-462-6432
Practice Address - Street 1:1036 S ODEN DR
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-9760
Practice Address - Country:US
Practice Address - Phone:317-462-1368
Practice Address - Fax:317-462-6432
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004219A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist