Provider Demographics
NPI:1780407940
Name:ROBERTSON, LATONJANETTE
Entity type:Individual
Prefix:MRS
First Name:LATONJANETTE
Middle Name:
Last Name:ROBERTSON
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 1:150 MEADOWS RD N APT 4
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1450
Mailing Address - Country:US
Mailing Address - Phone:414-699-4043
Mailing Address - Fax:
Practice Address - Street 1:1106 RIVERLANE DR
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-1947
Practice Address - Country:US
Practice Address - Phone:815-671-7092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist