Healthcare Provider Details

I. General information

NPI: 1750406484
Provider Name (Legal Business Name): LINDA ROBINSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA KOLOKOLO

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 EXCHANGE ST STE 301
ASTORIA OR
97103-3364
US

IV. Provider business mailing address

14600 NW CORNELL RD
PORTLAND OR
97229-5442
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-0241
  • Fax: 503-861-2043
Mailing address:
  • Phone: 503-629-3865
  • Fax: 503-533-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL2681
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: