Provider Demographics
NPI:1750354445
Name:ROBERTS, SUSAN L (MA, NCC, LCPC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MA, NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W LINCOLN HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3680
Mailing Address - Country:US
Mailing Address - Phone:815-754-9777
Mailing Address - Fax:
Practice Address - Street 1:151 W LINCOLN HWY
Practice Address - Street 2:SUITE C
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3680
Practice Address - Country:US
Practice Address - Phone:815-754-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-11
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004201101YM0800X
IL180-004201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL091193OtherHEALTH ALLIANCE
IL01932002OtherBLUE CROSS BLUE SHIELD
IL486660000OtherMAGELLAN BEHAVIORALHEALTH
IL364460074OtherUNITED BEHAVIORAL HEALTH
IL486660000OtherMAGELLAN BEHAVIORALHEALTH