Mallory Robertson

Primary specialty

Social WorkerTaxonomy code 104100000X

License

150119341 Issued in IL

Practice address

1802 Fox Dr Ste D
Champaign, IL 61820-7280

Phone

(217) 766-0258

Fax

(217) 883-4030

NPI assigned

Aug 7, 2026

Last updated

Aug 7, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mallory Craion Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Envisage Counseling Services LLC

  • Mental Health Counselor
  • Champaign, IL
  • NPI 1285375022
  NPD (past)

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

{
    "created_epoch": "1786060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786060800000",
    "number": "1649194044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 FOX DR STE D",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618207280",
            "telephone_number": "217-766-0258",
            "fax_number": "217-883-4030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 FOX DR STE D",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618207280",
            "telephone_number": "217-766-0258",
            "fax_number": "217-883-4030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "MALLORY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-08-07",
        "last_updated": "2026-08-07",
        "certification_date": "2026-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150119341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "CRAION",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hira Rizvi, M.D.
• Robert W Shafer DDS LTD
• Briana Roberts
• Timothy G Roberts, MD
• Grant Robertsa
• Gabriel Deshawn Robinson
• Huey G. Robinson, LPN
• Josephine Robinson
• Nakesha Rochelle Robinson
• Precious Robinson

• Social Worker in Champaign, IL
• Providers in Champaign, IL by specialty
• Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2026; 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.