Provider Demographics
NPI:1598052045
Name:ROBERTSON, JOSHUA WAYNE (LMSW)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:WAYNE
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-2353
Mailing Address - Country:US
Mailing Address - Phone:785-825-0541
Mailing Address - Fax:785-825-0062
Practice Address - Street 1:1421 W 8TH ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-4736
Practice Address - Country:US
Practice Address - Phone:620-326-3046
Practice Address - Fax:620-326-5587
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8094104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200727260AMedicaid