Healthcare Provider Details

I. General information

NPI: 1003070822
Provider Name (Legal Business Name): CYNTHIA JOANN ROBINSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 W MADISON ST
OTTAWA IL
61350-2833
US

IV. Provider business mailing address

424 W MADISON ST
OTTAWA IL
61350-2833
US

V. Phone/Fax

Practice location:
  • Phone: 815-431-3021
  • Fax: 815-433-3980
Mailing address:
  • Phone: 815-431-3021
  • Fax: 815-433-3980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.007877
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: