Provider Demographics
NPI:1730674938
Name:ROBERTSON, LATONEY (BTT)
Entity Type:Individual
Prefix:MRS
First Name:LATONEY
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:BTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5634
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-0634
Mailing Address - Country:US
Mailing Address - Phone:414-403-5757
Mailing Address - Fax:
Practice Address - Street 1:8815 W CONGRESS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-5026
Practice Address - Country:US
Practice Address - Phone:414-403-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty