Provider Demographics
NPI:1114617743
Name:ROBERTSON, DEVIN LAUREN
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:LAUREN
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DEVIN
Other - Middle Name:LAUREN
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4325 E 29TH ST LOT 97
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-8863
Mailing Address - Country:US
Mailing Address - Phone:515-443-2018
Mailing Address - Fax:
Practice Address - Street 1:2501 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5342
Practice Address - Country:US
Practice Address - Phone:515-808-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0908791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical