Provider Demographics
NPI:1235851999
Name:GROWNEY, ROBERTA J (SUDP)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:J
Last Name:GROWNEY
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GUNNYON RD
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-0386
Mailing Address - Country:US
Mailing Address - Phone:509-865-5121
Mailing Address - Fax:509-865-4333
Practice Address - Street 1:20 GUNNYON RD
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-9894
Practice Address - Country:US
Practice Address - Phone:509-865-5121
Practice Address - Fax:509-865-4333
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60048342101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty