Provider Demographics
NPI:1568904670
Name:ROBAK, WARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:WARD
Middle Name:
Last Name:ROBAK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N WASHINGTON ST STE 408
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-5001
Mailing Address - Country:US
Mailing Address - Phone:509-220-4398
Mailing Address - Fax:509-241-3864
Practice Address - Street 1:108 N WASHINGTON ST STE 408
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201
Practice Address - Country:US
Practice Address - Phone:509-220-4398
Practice Address - Fax:509-241-3864
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60608652101YP1600X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2075526Medicaid