Healthcare Provider Details

I. General information

NPI: 1982193108
Provider Name (Legal Business Name): NINA POLIGNONE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15127 S 73RD AVE STE C
ORLAND PARK IL
60462-3463
US

IV. Provider business mailing address

15127 S 73RD AVE STE C
ORLAND PARK IL
60462-4398
US

V. Phone/Fax

Practice location:
  • Phone: 630-225-8604
  • Fax:
Mailing address:
  • Phone: 708-586-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.016939
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: