Healthcare Provider Details

I. General information

NPI: 1629696935
Provider Name (Legal Business Name): ROBERT EVANS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5608 17TH AVE NW
SEATTLE WA
98107-5232
US

IV. Provider business mailing address

5608 17TH AVE NW STE 596
SEATTLE WA
98107-5232
US

V. Phone/Fax

Practice location:
  • Phone: 206-569-0801
  • Fax: 206-326-1777
Mailing address:
  • Phone: 206-569-0801
  • Fax: 206-326-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number624
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: