Provider Demographics
NPI:1588465900
Name:ROBERTS, MICHELLE LYNN
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:ROBERTS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 N ELM ST.
Mailing Address - Street 2:
Mailing Address - City:GRAYTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43432
Mailing Address - Country:US
Mailing Address - Phone:419-345-4929
Mailing Address - Fax:
Practice Address - Street 1:4352 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3463
Practice Address - Country:US
Practice Address - Phone:844-561-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH277279163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty