Provider Demographics
NPI:1053109785
Name:ROBERTSON, MINDY
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 DANWORTH CT
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-7139
Mailing Address - Country:US
Mailing Address - Phone:314-537-1976
Mailing Address - Fax:
Practice Address - Street 1:1027 DANWORTH CT
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-7139
Practice Address - Country:US
Practice Address - Phone:314-537-1976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130379371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical