Provider Demographics
NPI:1194148411
Name:ROBERTS, ANDREA MARIE (BS, MED, QMHA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:BS, MED, QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 25TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-0338
Mailing Address - Country:US
Mailing Address - Phone:503-373-0383
Mailing Address - Fax:503-373-0387
Practice Address - Street 1:4600 25TH AVE NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0338
Practice Address - Country:US
Practice Address - Phone:503-373-0383
Practice Address - Fax:503-373-0387
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator