Healthcare Provider Details

I. General information

NPI: 1033426101
Provider Name (Legal Business Name): ROBYN CHERISE BLODGETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROBYN CHERISE FRAZIER

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S PEARL ST
TACOMA WA
98465-2117
US

IV. Provider business mailing address

1201 S PROCTOR ST
TACOMA WA
98405-2047
US

V. Phone/Fax

Practice location:
  • Phone: 253-396-5930
  • Fax: 253-566-2252
Mailing address:
  • Phone: 253-396-5800
  • Fax: 253-566-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60155259
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: