Provider Demographics
NPI:1346731114
Name:BATHKE, ROBERT (CRM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BATHKE
Suffix:
Gender:M
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 HAMPDEN LN NE UNIT 22
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-3281
Mailing Address - Country:US
Mailing Address - Phone:503-586-6710
Mailing Address - Fax:
Practice Address - Street 1:525 FERRY ST SE STE 203
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3743
Practice Address - Country:US
Practice Address - Phone:503-363-6103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-28
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)