Krystal Roberts, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9838-123 Issued in WI

Practice address

6121 Green Bay Rd Ste 200
Kenosha, WI 53142-2931

Phone

(262) 864-1141

Fax

(262) 351-0132

NPI assigned

Jan 19, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Krystal Roberts Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ujima Living LLC

  • Clinical Social Worker
  • Zion, IL
  • NPI 1093569022
  NPD Authorized official
• Advance Clinical Services

  • Clinical Social Worker
  • Kenosha, WI
  • NPI 1124791595
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1356093678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7721 PERSHING BLVD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531424319",
            "telephone_number": "262-383-5420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6121 GREEN BAY RD STE 200",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422931",
            "telephone_number": "262-864-1141",
            "fax_number": "262-351-0132"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7721 Pershing Blvd",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531424319",
            "country_code": "US",
            "telephone_number": "262-308-3302",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "KRYSTAL",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-19",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9838-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100215279",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "wellnesskryss@gmail.com",
            "affiliation": "N",
            "address_1": "7721 Pershing Blvd",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531424319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KRYSTAL",
            "last_name": "ROBERTS",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Mitchell Robak, PHARMD
• Anne Robbins, C.T.P.
• Meredith Robbins, LPC, SAC
• Kimberly Roberson, PA
• Robert B. Bower, O.D., S.C.
• Laurie Ann Robertson, O.D.
• Amber Robinson, LPC-IT
• Barbara S Robinson, M.D.
• Dana Robinson
• Kelly Anthony Robinson, MD

• Clinical Social Worker in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.