Provider Demographics
NPI:1689706194
Name:HESS, ROBERT ALLEN (RAS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:HESS
Suffix:
Gender:M
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 11TH ST
Mailing Address - Street 2:SUITE B100
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2324
Mailing Address - Country:US
Mailing Address - Phone:209-567-4157
Mailing Address - Fax:209-567-4188
Practice Address - Street 1:801 11TH ST
Practice Address - Street 2:SUITE B100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2324
Practice Address - Country:US
Practice Address - Phone:209-567-4157
Practice Address - Fax:209-567-4188
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAH0407281305101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)