Healthcare Provider Details

I. General information

NPI: 1730544925
Provider Name (Legal Business Name): ROBINSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3335 S INDIANA AVE
CHICAGO IL
60616-3838
US

IV. Provider business mailing address

3335 S INDIANA AVE
CHICAGO IL
60616-3838
US

V. Phone/Fax

Practice location:
  • Phone: 708-253-9271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE S ROBINSON
Title or Position: OWNER
Credential: DT
Phone: 708-253-9271