Healthcare Provider Details

I. General information

NPI: 1568297745
Provider Name (Legal Business Name): ROBERT JOHN SEEMANN CSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 SW 67TH AVE
TIGARD OR
97223-8589
US

IV. Provider business mailing address

11650 SW 67TH AVE
TIGARD OR
97223-8589
US

V. Phone/Fax

Practice location:
  • Phone: 503-208-4563
  • Fax:
Mailing address:
  • Phone: 503-208-4563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA15583
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: