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General NPI Number Information
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NPI Number | 1174400139
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Entity Type | Individual
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Provider Name | LASHONDA ROBERTSON CSA
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Gender | Female
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 1827 W BROADWAY
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City | LOUISVILLE
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State | KY
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Zip | 40203-3547
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Country | US
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Telephone | 502-963-5792
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Fax | 502-653-7063
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Provider Business Mailing Address
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Address Line | 11126 COMPASS AVE
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City | LOUISVILLE
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State | KY
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Zip | 40229-8391
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Country | US
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Telephone | 502-612-5495
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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