Provider Demographics
NPI:1851450126
Name:SHULTZ, ROBIN SIEBURG (LCSW,LMFT,CADC,CTRS)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:SIEBURG
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:LCSW,LMFT,CADC,CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 FOX TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-8637
Mailing Address - Country:US
Mailing Address - Phone:630-406-1093
Mailing Address - Fax:
Practice Address - Street 1:115 CAMPBELL ST
Practice Address - Street 2:SUITE 200A
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2784
Practice Address - Country:US
Practice Address - Phone:630-828-6303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2015-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17694101YA0400X
IL149-011-0111041C0700X
IL166.000989106H00000X
IL20063031041S0200X
IL22274225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3673276ZMedicaid