Healthcare Provider Details

I. General information

NPI: 1316173719
Provider Name (Legal Business Name): ROBIN B KROLL PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 N AVONDALE AVE #111
CHICAGO IL
60631
US

IV. Provider business mailing address

6323 N AVONDALE AVE #111
CHICAGO IL
60631
US

V. Phone/Fax

Practice location:
  • Phone: 847-778-9322
  • Fax: 847-726-9320
Mailing address:
  • Phone: 847-778-9322
  • Fax: 847-726-9320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number071007698
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071007698
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: