Provider Demographics
NPI:1285954065
Name:ROBERTS, JOANNE (SAC; LPC; CNA)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:SAC; LPC; CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 CHIPPEWA TRL
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-3819
Mailing Address - Country:US
Mailing Address - Phone:608-299-8089
Mailing Address - Fax:
Practice Address - Street 1:1919 CHIPPEWA TRL
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-3819
Practice Address - Country:US
Practice Address - Phone:608-299-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11763-131101YA0400X
WI2667-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)