Provider Demographics
NPI:1679348494
Name:ROBERSON, EMILY SMITH (MS, CGC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SMITH
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 W DEMPSTER ST STE 285
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1157
Mailing Address - Country:US
Mailing Address - Phone:847-723-7705
Mailing Address - Fax:
Practice Address - Street 1:1875 W DEMPSTER ST STE 285
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1157
Practice Address - Country:US
Practice Address - Phone:847-723-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246.000894170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS