Basic Information
| Provider Information | |||||||||
| NPI: | 1871711929 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAXON | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | AU.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1613 5TH ST | ||||||||
| Address2: | |||||||||
| City: | LA GRANDE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978502515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416050550 | ||||||||
| FaxNumber: | 5416050552 | ||||||||
| Practice Location | |||||||||
| Address1: | 1613 5TH ST | ||||||||
| Address2: | |||||||||
| City: | LA GRANDE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978502515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416050550 | ||||||||
| FaxNumber: | 5416050552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 01/07/2015 | ||||||||
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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 | 231H00000X | 21908 | OR | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 028030000 | 01 | OR | BLUE CROSS BLUE SHIELD | OTHER | 640003829 | 01 | OR | RAILROAD MEDICARE | OTHER | 158836 | 05 | OR | MEDICAID | I056301 | 01 | OR | PACIFIC SOURCE | OTHER |