Provider Demographics
NPI:1548659188
Name:MAGDAHLEN, ROBIN LYNN (MA RDT, LPC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:MAGDAHLEN
Suffix:
Gender:F
Credentials:MA RDT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 SW MULTNOMAH BLVD
Mailing Address - Street 2:#103
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-4025
Mailing Address - Country:US
Mailing Address - Phone:503-380-2049
Mailing Address - Fax:
Practice Address - Street 1:2929 SW MULTNOMAH BLVD
Practice Address - Street 2:#103
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-4025
Practice Address - Country:US
Practice Address - Phone:503-380-2049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR#C3647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional