Individual
MR. SCOTT ROBERTSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CG60940327
Contact information
Practice address
151 N MARKET BLVD STE D, CHEHALIS, WA 98532-2677
(360) 948-0288
Mailing address
115 JALYN ST, CENTRALIA, WA 98531-1730
(360) 807-3597
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG60940327
COUNSELOR AGENCY AFFILIATED REGISTRATION
WA
Enumeration date
03/01/2019
Last updated
03/01/2019
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