Provider Demographics
NPI:1366835548
Name:BALLARD, ROBIN HANSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:HANSON
Last Name:BALLARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 6TH AVE SE STE C
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1072
Mailing Address - Country:US
Mailing Address - Phone:206-910-5025
Mailing Address - Fax:
Practice Address - Street 1:4313 6TH AVE SE STE C
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1072
Practice Address - Country:US
Practice Address - Phone:206-910-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60512398103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical