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General NPI Number Information
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NPI Number | 1619373107
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Entity Type | Individual
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Provider Name | NICOLE ROBERTSON APSW
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Gender | Female
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 3600 30TH STREET MENTAL HEALTH 116A
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City | DES MOINES
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State | IA
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Zip | 50310
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Country | US
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Telephone | 515-699-5999
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Fax |
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Provider Business Mailing Address
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Address Line | 8337 COLBY PKWY APT 442
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City | URBANDALE
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State | IA
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Zip | 50322-7040
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Country | US
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Telephone | 215-806-3322
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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 | 128759-121
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License Number State | WI
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