Provider Demographics
NPI:1083873129
Name:ROBERTS, JENNIFER A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SPINNING WHEEL ROAD
Mailing Address - Street 2:SUITE 426
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2914
Mailing Address - Country:US
Mailing Address - Phone:630-323-3050
Mailing Address - Fax:630-323-3058
Practice Address - Street 1:15 SPINNING WHEEL ROAD
Practice Address - Street 2:SUITE 426
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2914
Practice Address - Country:US
Practice Address - Phone:630-323-3050
Practice Address - Fax:630-323-3058
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL071007483103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633920OtherBCBS