Provider Demographics
NPI:1023802543
Name:ROBERTSON, BRIANNA DANAE
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:DANAE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37W002 MOOSEHEART RD
Mailing Address - Street 2:
Mailing Address - City:MOOSEHEART
Mailing Address - State:IL
Mailing Address - Zip Code:60539-1022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37W002 MOOSEHEART RD
Practice Address - Street 2:
Practice Address - City:MOOSEHEART
Practice Address - State:IL
Practice Address - Zip Code:60539-1022
Practice Address - Country:US
Practice Address - Phone:630-541-3652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist