Healthcare Provider Details

I. General information

NPI: 1740748292
Provider Name (Legal Business Name): ROBIN KATHLEEN BODHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 METZGER RD
CARSON WA
98610-3098
US

IV. Provider business mailing address

52 METZGER RD
CARSON WA
98610-3098
US

V. Phone/Fax

Practice location:
  • Phone: 503-658-9557
  • Fax:
Mailing address:
  • Phone: 503-477-0931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR7677
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12722
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61683391
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: