MEDICARE: DEVIN LAUREN ROBERTSON

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
1	1041C0700X	Clinical Social Worker	090879	IA

General Provider Information

NPI Number	:	1114617743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVIN LAUREN ROBERTSON

Provider Business Mailing Address
First Line	:	3108 NW 19TH ST
Second Line	:
City	:	ANKENY
State	:	IA
Zip	:	50023-8035
Country	:	US
Telephone Number	:	515-443-2018
Fax Number	:

Provider Business Practice Location Address
First Line	:	1706 6TH AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50314-3337
Country	:	US
Telephone Number	:	515-443-2018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	03/20/2026

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