Provider Demographics
NPI:1881898062
Name:ROBERTSON, JASON D (LAC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 NW 83RD ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3043
Mailing Address - Country:US
Mailing Address - Phone:206-920-5205
Mailing Address - Fax:
Practice Address - Street 1:1904 3RD AVE
Practice Address - Street 2:SUITE 535
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1126
Practice Address - Country:US
Practice Address - Phone:206-920-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002447171100000X
CAAC7825171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist