Healthcare Provider Details

I. General information

NPI: 1114617743
Provider Name (Legal Business Name): DEVIN LAUREN ROBERTSON MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DEVIN LAUREN ROBERTSON MSW, LCSW

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N JOHN WAYNE DR
WINTERSET IA
50273-1501
US

IV. Provider business mailing address

113 N JOHN WAYNE DR
WINTERSET IA
50273-1501
US

V. Phone/Fax

Practice location:
  • Phone: 515-462-5967
  • Fax: 515-462-5981
Mailing address:
  • Phone: 515-462-5967
  • Fax: 515-462-5981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number090879
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: