Provider Demographics
NPI:1972088391
Name:DEERING, ROBBIE
Entity Type:Individual
Prefix:
First Name:ROBBIE
Middle Name:
Last Name:DEERING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ENTERPRISE AVE NE STE 7
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-6814
Mailing Address - Country:US
Mailing Address - Phone:763-200-3411
Mailing Address - Fax:
Practice Address - Street 1:4 ENTERPRISE AVE NE STE 7
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-6814
Practice Address - Country:US
Practice Address - Phone:763-200-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist