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General NPI Number Information
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NPI Number | 1578190989
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Entity Type | Individual
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Provider Name | BRENNA NICOLE ROBERTSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 1408 POYNTZ AVE
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City | MANHATTAN
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State | KS
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Zip | 66502-4145
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Country | US
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Telephone | 785-776-4105
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Fax |
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Provider Business Mailing Address
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Address Line | 807 ALLISON AVE APT B
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City | MANHATTAN
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State | KS
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Zip | 66502-3328
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Country | US
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Telephone | 435-256-5613
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 12351534-3503
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14259
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License Number State | KS
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