Provider Demographics
NPI:1447626080
Name:ROBERTSON, SHELBY (BA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 ROYAL SAINT GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1939
Mailing Address - Country:US
Mailing Address - Phone:317-607-9709
Mailing Address - Fax:
Practice Address - Street 1:645 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3846
Practice Address - Country:US
Practice Address - Phone:812-336-3570
Practice Address - Fax:812-336-9010
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker