Provider Demographics
NPI:1831210400
Name:JACKSON, ROBIN DOROTHY (LMP,LST)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:DOROTHY
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LMP,LST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 N DIVISION ST STE I
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5915
Mailing Address - Country:US
Mailing Address - Phone:509-999-1218
Mailing Address - Fax:
Practice Address - Street 1:8601 N DIVISION ST STE I
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5915
Practice Address - Country:US
Practice Address - Phone:509-999-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017035174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist