Individual
KRYSTAL ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6121 GREEN BAY RD STE 200, KENOSHA, WI 53142-2931
(262) 864-1141
(262) 351-0132
Mailing address
7721 PERSHING BLVD, KENOSHA, WI 53142-4319
(262) 383-5420
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9838-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100215279
—
WI
Enumeration date
01/19/2022
Last updated
09/13/2023
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