Healthcare Provider Details

I. General information

NPI: 1538046073
Provider Name (Legal Business Name): JOSLYNNE ROBERTS ED.S, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N ST
HEYBURN ID
83336-8659
US

IV. Provider business mailing address

1901 N ST
HEYBURN ID
83336-8659
US

V. Phone/Fax

Practice location:
  • Phone: 706-405-9774
  • Fax:
Mailing address:
  • Phone: 706-405-9774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number82598
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number663329576
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number20230009501
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: