Provider Demographics
NPI:1598079469
Name:GRACE, ROBIN L (MSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:GRACE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1001
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-1001
Mailing Address - Country:US
Mailing Address - Phone:907-766-2877
Mailing Address - Fax:
Practice Address - Street 1:492 E 13TH AVE
Practice Address - Street 2:STE 203
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4250
Practice Address - Country:US
Practice Address - Phone:541-914-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6121041C0700X
WAL 000069601041C0700X
NYR034170-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical