Marissa Robertson

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SI61102446 Issued in WA

Practice address

516 Main St
Lynden, WA 98264-1326

Phone

(360) 354-4443

Fax

(360) 354-7662

NPI assigned

Feb 26, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: robertsonm@lynden.wednet.edu

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1770177925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1485 SWEETBAY DR",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982295361",
            "telephone_number": "206-779-7867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 MAIN ST",
            "city": "LYNDEN",
            "state": "WA",
            "postal_code": "982641326",
            "telephone_number": "360-354-4443",
            "fax_number": "360-354-7662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "MARISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-26",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "SI61102446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "RobertsonM@lynden.wednet.edu",
            "affiliation": "N",
            "endpointDescription": "Work Email",
            "address_1": "516 Main St",
            "city": "Lynden",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982641326",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Speech-Language Pathologist in Lynden, WA
• Providers in Lynden, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.