Healthcare Provider Details

I. General information

NPI: 1568326486
Provider Name (Legal Business Name): JOSEPH A ROBERTS III
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N GRAPE ST
MEDFORD OR
97501-2718
US

IV. Provider business mailing address

101 N GRAPE ST
MEDFORD OR
97501-2718
US

V. Phone/Fax

Practice location:
  • Phone: 541-776-8590
  • Fax:
Mailing address:
  • Phone: 541-776-8590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: