Provider Demographics
NPI:1174943062
Name:ROBERSON, MICHELLE (LMSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6724 NW HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-1206
Mailing Address - Country:US
Mailing Address - Phone:913-732-2298
Mailing Address - Fax:844-331-5343
Practice Address - Street 1:110 N CHERRY ST STE 100
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061
Practice Address - Country:US
Practice Address - Phone:913-732-2298
Practice Address - Fax:844-331-5343
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8613104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1174943062Medicaid