Individual
CODY BLAKE ROBINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
404 REVERE ST, KINGSPORT, TN 37660-3671
(423) 246-4600
Mailing address
404 REVERE ST, KINGSPORT, TN 37660-3671
(423) 246-4600
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004978048
MEDICAID
VA
05
—
0446506
—
TN
Enumeration date
06/22/2009
Last updated
06/23/2009
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