Provider Demographics
NPI:1043365125
Name:ROBERTSON, KAREN LEE (CDP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LEE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12104 SE 44TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1912
Mailing Address - Country:US
Mailing Address - Phone:425-333-5426
Mailing Address - Fax:
Practice Address - Street 1:4480 TOLT AVE
Practice Address - Street 2:
Practice Address - City:CARNATION
Practice Address - State:WA
Practice Address - Zip Code:98014
Practice Address - Country:US
Practice Address - Phone:425-333-5426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002814174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1994680OtherCHEMICAL DEPENDENCY
WA113500OtherDASA