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NPI Code Detail

MEDICARE: KRISTIN ROBERTS MA

MEDICARE: KRISTIN ROBERTS MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramCO60704002WA
2101YM0800XMental Health CounselorMC60624596WA

General Provider Information

NPI Number : 1710385067
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN ROBERTS MA
Provider Business Mailing Address
First Line : 12127 SE 160TH ST
Second Line :
City : RENTON
State : WA
Zip : 98058-5312
Country : US
Telephone Number : 425-331-9308
Fax Number :
Provider Business Practice Location Address
First Line : 7100 FORT DENT WAY STE 220
Second Line :
City : TUKWILA
State : WA
Zip : 98188-8553
Country : US
Telephone Number : 206-708-7274
Fax Number : 206-444-7810
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2014
Last Update Date : 01/12/2021

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