Individual
MR. ROBERT BENTON BLACK II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S. SLP
Contact information
Practice address
431 W RACE ST, ROLLING FORK, MS 39159-2625
(662) 795-0440
Mailing address
431 W RACE ST, ROLLING FORK, MS 39159-2625
(662) 571-7667
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S5249
MS
Other
Enumeration date
09/11/2024
Last updated
09/11/2024
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