Healthcare Provider Details

I. General information

NPI: 1003479106
Provider Name (Legal Business Name): SARAH LYNN ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 NE OAK VIEW DR
VANCOUVER WA
98662-6157
US

IV. Provider business mailing address

2807 NE 93RD AVE
VANCOUVER WA
98662-7429
US

V. Phone/Fax

Practice location:
  • Phone: 360-567-2211
  • Fax:
Mailing address:
  • Phone: 360-980-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: