Provider Demographics
NPI:1053504027
Name:ROBERTS, JEAN A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:A
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8970
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-0970
Mailing Address - Country:US
Mailing Address - Phone:419-517-1758
Mailing Address - Fax:419-517-1399
Practice Address - Street 1:2109 HUGHES DR
Practice Address - Street 2:JOBST TOWER #640
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3856
Practice Address - Country:US
Practice Address - Phone:567-661-0505
Practice Address - Fax:419-291-6436
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0007114-S101YP2500X
OH6879103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional