Provider Demographics
NPI:1508058819
Name:ROBERSON, KENDRA CORR (PHD)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:CORR
Last Name:ROBERSON
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 1:4006 NORTHSHORE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-2209
Mailing Address - Country:US
Mailing Address - Phone:253-952-0441
Mailing Address - Fax:
Practice Address - Street 1:4041 RUSTON WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5378
Practice Address - Country:US
Practice Address - Phone:253-830-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000093451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical