Individual
GWENDOLYN EARLE ROBERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD, MA
Contact information
Practice address
1120 ROUTE 73 STE 300, MOUNT LAUREL, NJ 08054-5113
(856) 930-4097
Mailing address
82 S 1100 E, 404, SALT LAKE CITY, UT 84102-1686
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
7770041-1205
UT
2084P0800X
Psychiatry Physician
70664
MN
2084P0800X
Psychiatry Physician
74047
AZ
2084P0800X
Psychiatry Physician
Primary
7770041-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558504191
—
UT
Enumeration date
04/13/2009
Last updated
07/05/2024
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