Provider Demographics
NPI:1376363549
Name:ROBINSON, ROXSIE SERENITY
Entity type:Individual
Prefix:
First Name:ROXSIE
Middle Name:SERENITY
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110287 VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2606
Mailing Address - Country:US
Mailing Address - Phone:612-810-4786
Mailing Address - Fax:
Practice Address - Street 1:4201 DEAN LAKES BLVD STE 160
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2863
Practice Address - Country:US
Practice Address - Phone:612-509-6681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician