Provider Demographics
NPI:1699552968
Name:ROBERTSON, MICHELLE L (MA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 SW HAMPTON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8381
Mailing Address - Country:US
Mailing Address - Phone:503-619-6643
Mailing Address - Fax:971-351-6978
Practice Address - Street 1:6950 SW HAMPTON ST STE 205
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8381
Practice Address - Country:US
Practice Address - Phone:503-619-6643
Practice Address - Fax:971-351-6978
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR8416106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist