1730282310 NPI number — MRS. LYNNE F ROBERTSON MA CCC SLP

Table of content: MRS. LYNNE F ROBERTSON MA CCC SLP (NPI 1730282310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730282310 NPI number — MRS. LYNNE F ROBERTSON MA CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTSON
Provider First Name:
LYNNE
Provider Middle Name:
F
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730282310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1195 OLD HICKORY BLVD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-4239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-376-3045
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5819 OLD HARDING RD
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-353-6400
Provider Business Practice Location Address Fax Number:
615-353-6412
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP0000000697 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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