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General NPI Number Information
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NPI Number | 1114617743
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Entity Type | Individual
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Provider Name | DEVIN LAUREN ROBERTSON
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Gender | Male
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 2501 GRAND AVE
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City | DES MOINES
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State | IA
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Zip | 50312-5342
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Country | US
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Telephone | 515-808-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 4325 E 29TH ST LOT 97
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City | DES MOINES
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State | IA
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Zip | 50317-8863
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Country | US
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Telephone | 515-443-2018
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 090879
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License Number State | IA
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