Individual
MICHAEL ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SAC-IT
Contact information
Practice address
3733 DEWEY ST, MANITOWOC, WI 54220-5844
(920) 663-1035
Mailing address
3733 DEWEY ST, MANITOWOC, WI 54220-5844
(920) 663-1035
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19720130
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100202048
—
WI
Enumeration date
05/23/2022
Last updated
01/10/2023
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