Provider Demographics
NPI:1467581074
Name:ROBINSON, WENDY (LICSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N 5TH AVE SW APT B
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6461
Mailing Address - Country:US
Mailing Address - Phone:503-812-3986
Mailing Address - Fax:
Practice Address - Street 1:325 N 5TH AVE SW APT B
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-6461
Practice Address - Country:US
Practice Address - Phone:503-812-3986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL31581041C0700X, 1041C0700X
WALW000075151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR197749Medicaid
OR197749Medicaid