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NPI Code Detail

MEDICARE: JALEESA RENE ROBERSON

MEDICARE: JALEESA RENE ROBERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool Psychologist

General Provider Information

NPI Number : 1013856111
Entity Type Code : Individual
Provider Name (Legal Business Name) : JALEESA RENE ROBERSON
Provider Business Mailing Address
First Line : 17100 E SHEA BLVD STE 600
Second Line :
City : FOUNTAIN HILLS
State : AZ
Zip : 85268-6663
Country : US
Telephone Number : 623-428-9065
Fax Number :
Provider Business Practice Location Address
First Line : 17100 E SHEA BLVD STE 600
Second Line :
City : FOUNTAIN HILLS
State : AZ
Zip : 85268-6663
Country : US
Telephone Number : 623-428-9065
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2026
Last Update Date : 04/06/2026

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