Healthcare Provider Details

I. General information

NPI: 1194402826
Provider Name (Legal Business Name): MRS. VEDA SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. VEDA SMITH-SIMMONS

II. Dates (important events)

Enumeration Date: 07/04/2023
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 HARLEM AVE
RIVERSIDE IL
60546-2012
US

IV. Provider business mailing address

414 PLAZA DR STE 301
WESTMONT IL
60559-5508
US

V. Phone/Fax

Practice location:
  • Phone: 630-728-1744
  • Fax: 630-998-7029
Mailing address:
  • Phone: 513-324-3562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.018687
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: