Healthcare Provider Details

I. General information

NPI: 1669312518
Provider Name (Legal Business Name): ROBERTA WEST LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 W TOWNLINE RD
PEORIA IL
61615-1621
US

IV. Provider business mailing address

1913 W TOWNLINE RD
PEORIA IL
61615-1621
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-3800
  • Fax:
Mailing address:
  • Phone: 309-691-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.005013
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: