Provider Information for 1417386699
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SANDRA ROBERTS LCPC
Sex: Female
NPI: 1417386699
Last Updated: 2023-07-21
Certification Date: 2023-07-21
Certification Date: 2023-07-21
Details
| Name | Value | ||||||||||||||||
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| NPI | 1417386699 | ||||||||||||||||
| Enumeration Date | 2013-11-07 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 2134 W LAWRENCE AVE SPRINGFIELD, IL 62704-1417 United States Phone: 217-565-0014 | Fax: | ||||||||||||||||
| Primary Practice Address | 2134 W LAWRENCE AVE SPRINGFIELD, IL 62704-1417 United States Phone: 217-565-0014 | Fax: | ||||||||||||||||
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