Provider Demographics
NPI:1972046563
Name:ROBERTSON, LAUREL A (CDCA)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:A
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3963
Mailing Address - Country:US
Mailing Address - Phone:330-270-3660
Mailing Address - Fax:330-953-3691
Practice Address - Street 1:102 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-3963
Practice Address - Country:US
Practice Address - Phone:330-270-3660
Practice Address - Fax:330-953-3691
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH160471174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist