Provider Demographics
NPI:1174932123
Name:ROBERTSON, ASTRID LEE (MA)
Entity type:Individual
Prefix:
First Name:ASTRID
Middle Name:LEE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ASTRID
Other - Middle Name:LEE
Other - Last Name:JANSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3912 MARTIN WAY E
Mailing Address - Street 2:SUITE D
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5220
Mailing Address - Country:US
Mailing Address - Phone:360-890-2046
Mailing Address - Fax:
Practice Address - Street 1:3912 MARTIN WAY E
Practice Address - Street 2:SUITE D
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5220
Practice Address - Country:US
Practice Address - Phone:360-890-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60482700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health