Healthcare Provider Details

I. General information

NPI: 1255186292
Provider Name (Legal Business Name): MS. NAOMI MIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 04/23/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 N CICERO AVE STE 220
LINCOLNWOOD IL
60712-1627
US

IV. Provider business mailing address

2847 N ELSTON AVE
CHICAGO IL
60618-7905
US

V. Phone/Fax

Practice location:
  • Phone: 877-486-4140
  • Fax:
Mailing address:
  • Phone: 312-833-8533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: