=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457204141
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE ERIN ROBERTSON MA, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2026
-----------------------------------------------------
Last Update Date | 02/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 E NORTH ST STE B
-----------------------------------------------------
City | BRADLEY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60915-1186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-322-7254
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 E CORNING AVE
-----------------------------------------------------
City | PEOTONE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60468-8804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-609-9463
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 178.022695
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------