Healthcare Provider Details

I. General information

NPI: 1568434306
Provider Name (Legal Business Name): SARAH KATHERINE ROBERTSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE ROBERTSON MA

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 W BRIGHTON AVE
PEORIA IL
61615-2938
US

IV. Provider business mailing address

1014 EISENHOWER DR
PEKIN IL
61554-1508
US

V. Phone/Fax

Practice location:
  • Phone: 309-692-7755
  • Fax: 309-692-2262
Mailing address:
  • Phone: 309-241-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180006038
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: