Provider Demographics
NPI:1366181422
Name:ROBY, CHISA ANN (ASSOCIATE LICENSE)
Entity type:Individual
Prefix:MRS
First Name:CHISA
Middle Name:ANN
Last Name:ROBY
Suffix:
Gender:F
Credentials:ASSOCIATE LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1351
Mailing Address - Country:US
Mailing Address - Phone:708-263-8624
Mailing Address - Fax:
Practice Address - Street 1:5715 POINTE DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-2387
Practice Address - Country:US
Practice Address - Phone:170-826-3862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health