Provider Demographics
NPI:1538704598
Name:ROBERTS, ASHLEIGH GRAYCE (LCSW)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:GRAYCE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 N CARLY CIR
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-8308
Mailing Address - Country:US
Mailing Address - Phone:309-264-2744
Mailing Address - Fax:
Practice Address - Street 1:24402 W LOCKPORT ST STE 223
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-4267
Practice Address - Country:US
Practice Address - Phone:630-621-5824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0166261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical