Healthcare Provider Details

I. General information

NPI: 1831985654
Provider Name (Legal Business Name): VICTORIA ROTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 E LINCOLN HWY
NEW LENOX IL
60451-2153
US

IV. Provider business mailing address

8899 S MAIN ST
HOMETOWN IL
60456-1149
US

V. Phone/Fax

Practice location:
  • Phone: 815-462-4273
  • Fax:
Mailing address:
  • Phone: 708-407-3470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.021501
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: