1174943062 NPI number — MICHELLE ROBERSON LMSW

Table of content: MICHELLE ROBERSON LMSW (NPI 1174943062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174943062 NPI number — MICHELLE ROBERSON LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERSON
Provider First Name:
MICHELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174943062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6724 NW HIDDEN VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64152-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-732-2298
Provider Business Mailing Address Fax Number:
844-331-5343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 N CHERRY ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-732-2298
Provider Business Practice Location Address Fax Number:
844-331-5343
Provider Enumeration Date:
04/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  8613 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1174943062 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com