Provider Demographics
NPI:1285879825
Name:STOFFREGEN, ROBERT ERIC
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ERIC
Last Name:STOFFREGEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:STOFFREGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:707 W 7TH AVE
Mailing Address - Street 2:SUITE 223
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2832
Mailing Address - Country:US
Mailing Address - Phone:509-455-9104
Mailing Address - Fax:509-455-7171
Practice Address - Street 1:707 W 7TH AVE
Practice Address - Street 2:SUITE 223
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2832
Practice Address - Country:US
Practice Address - Phone:509-455-9104
Practice Address - Fax:509-455-7171
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health