Provider Demographics
NPI:1679924476
Name:STEVENS, ROBERT (HIS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 WASHINGTON WAY
Mailing Address - Street 2:111
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4096
Mailing Address - Country:US
Mailing Address - Phone:360-425-7960
Mailing Address - Fax:360-425-9206
Practice Address - Street 1:945 WASHINGTON WAY
Practice Address - Street 2:111
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4096
Practice Address - Country:US
Practice Address - Phone:360-425-7960
Practice Address - Fax:360-425-9206
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA60631484237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist