Healthcare Provider Details

I. General information

NPI: 1508676669
Provider Name (Legal Business Name): VERONICA MONCIA ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10436 SOUTHWEST HWY
CHICAGO RIDGE IL
60415-2282
US

IV. Provider business mailing address

10436 SOUTHWEST HWY
CHICAGO RIDGE IL
60415-2282
US

V. Phone/Fax

Practice location:
  • Phone: 708-444-0304
  • Fax:
Mailing address:
  • Phone: 708-444-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number33755
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: