Healthcare Provider Details

I. General information

NPI: 1699101915
Provider Name (Legal Business Name): JANICE LOUISE ROBINSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14954 N COEUR DALENE ST
RATHDRUM ID
83858-6484
US

IV. Provider business mailing address

14954 N COEUR DALENE ST
RATHDRUM ID
83858-6484
US

V. Phone/Fax

Practice location:
  • Phone: 208-687-0538
  • Fax: 208-687-3185
Mailing address:
  • Phone: 208-687-0538
  • Fax: 208-687-3185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 32369
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: