Healthcare Provider Details

I. General information

NPI: 1104013259
Provider Name (Legal Business Name): CHRISTOPHER J ROBB LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38872 PROCTOR BLVD
SANDY OR
97055-8035
US

IV. Provider business mailing address

140 SOUTH HOLLY STREET
MEDFORD OR
97501
US

V. Phone/Fax

Practice location:
  • Phone: 503-722-6950
  • Fax:
Mailing address:
  • Phone: 541-774-8200
  • Fax: 541-774-7964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 3436
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL5986
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: