Provider Demographics
NPI:1568654796
Name:ROBINSON, WILLOW MICHELLE (LMP)
Entity Type:Individual
Prefix:MS
First Name:WILLOW
Middle Name:MICHELLE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 SE 187TH PL
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9767
Mailing Address - Country:US
Mailing Address - Phone:360-921-5004
Mailing Address - Fax:
Practice Address - Street 1:14415 SE MILL PLAIN BLVD
Practice Address - Street 2:SUITE 112-B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-3543
Practice Address - Country:US
Practice Address - Phone:360-253-1497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-12
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022694174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist