Provider Demographics
NPI:1679018956
Name:ROBERTS, RHEANELL (MA)
Entity type:Individual
Prefix:
First Name:RHEANELL
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:RHEANELL
Other - Middle Name:ROBERTS
Other - Last Name:PLOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11000 LAKE CITY WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6748
Mailing Address - Country:US
Mailing Address - Phone:206-461-3614
Mailing Address - Fax:206-634-3596
Practice Address - Street 1:11000 LAKE CITY WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6748
Practice Address - Country:US
Practice Address - Phone:206-461-3614
Practice Address - Fax:206-634-3596
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60676977171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator