Basic Information
| Provider Information | |||||||||
| NPI: | 1720169774 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | JANETTE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BROADNAX | ||||||||
| OtherFirstName: | MONICA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 741 KENILWORTH AVENUE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282043874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045238027 | ||||||||
| FaxNumber: | 7045238031 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224015719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403733223 | ||||||||
| FaxNumber: | 5403713753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7457 | NC | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 2202009158 | VA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 7412706 | 05 | NC | MEDICAID |