Healthcare Provider Details

I. General information

NPI: 1821360900
Provider Name (Legal Business Name): ROBIN GILSON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 W FOSTER AVE STE 412
CHICAGO IL
60625-3532
US

IV. Provider business mailing address

2740 W FOSTER AVE STE 310
CHICAGO IL
60625-3547
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-8200
  • Fax: 773-293-8804
Mailing address:
  • Phone: 773-878-8200
  • Fax: 773-293-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007926
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: