Basic Information
| Provider Information | |||||||||
| NPI: | 1760547780 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLCOMB | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | DAWN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA CCC SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BELANGER | ||||||||
| OtherFirstName: | ROBIN | ||||||||
| OtherMiddleName: | DAWN | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MA CCC SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5 ESTHER AVENUE | ||||||||
| Address2: | |||||||||
| City: | NORTH ATTLEBORO | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083865240 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | SOUTH BAY EARLY INTERVENTION | ||||||||
| Address2: | 1115 WEST CHESTNUT ST | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085590473 | ||||||||
| FaxNumber: | 5084275361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 6630 | MA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 12022158 | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.