Healthcare Provider Details

I. General information

NPI: 1174224414
Provider Name (Legal Business Name): CORNERSTONE CENTER FOR DEVELOPMENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 KRESKY AVE STE 108
CENTRALIA WA
98531-8982
US

IV. Provider business mailing address

1611 KRESKY AVE STE 108
CENTRALIA WA
98531-8982
US

V. Phone/Fax

Practice location:
  • Phone: 360-207-4196
  • Fax:
Mailing address:
  • Phone: 360-207-4196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SARAH ELIZABETH ROBBINS
Title or Position: SLP
Credential:
Phone: 419-357-3292