MEDICARE: ROSHANNA LOUISE ROBINSON LSCSW

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	05583	KS
2	104100000X	Social Worker	05583	KS

General Provider Information

NPI Number	:	1912679002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSHANNA LOUISE ROBINSON LSCSW

Provider Business Mailing Address
First Line	:	650 HUEBNER RD
Second Line	:
City	:	FORT RILEY
State	:	KS
Zip	:	66442-4030
Country	:	US
Telephone Number	:	785-239-7060
Fax Number	:

Provider Business Practice Location Address
First Line	:	7672 PARKER ST
Second Line	:
City	:	FORT RILEY
State	:	KS
Zip	:	66442-4247
Country	:	US
Telephone Number	:	785-239-1779
Fax Number	:

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

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	03/28/2023

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