Healthcare Provider Details

I. General information

NPI: 1568372357
Provider Name (Legal Business Name): NIKITA ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 W 105TH ST APT 3E
OAK LAWN IL
60453-4365
US

IV. Provider business mailing address

5800 W 105TH ST APT 3E
OAK LAWN IL
60453-4365
US

V. Phone/Fax

Practice location:
  • Phone: 773-885-6815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.033310
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: