Provider Demographics
NPI:1982639753
Name:VAN BOMMEL, ROBIN BRADY (MSSW,LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:BRADY
Last Name:VAN BOMMEL
Suffix:
Gender:F
Credentials:MSSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 N. ASSEMBLY STREET
Mailing Address - Street 2:ATT:P&CCS (122)
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6197
Mailing Address - Country:US
Mailing Address - Phone:509-434-7769
Mailing Address - Fax:509-434-7129
Practice Address - Street 1:4815 N ASSEMBLY ST
Practice Address - Street 2:ATT:P&CCS (122)
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6185
Practice Address - Country:US
Practice Address - Phone:509-434-7769
Practice Address - Fax:509-434-7129
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000001050284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital