Provider Demographics
NPI:1083767073
Name:MYERS, ROBERTA HEATHER (MSW)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:HEATHER
Last Name:MYERS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 173RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5720
Mailing Address - Country:US
Mailing Address - Phone:425-452-9605
Mailing Address - Fax:
Practice Address - Street 1:375 118TH AVE SE
Practice Address - Street 2:220
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3575
Practice Address - Country:US
Practice Address - Phone:425-452-9605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000043021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMY7714OtherREGENCE BLUE SHIELD