Healthcare Provider Details

I. General information

NPI: 1073357166
Provider Name (Legal Business Name): VICTORIA KENDALL HOLTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 HICKS RD
ROLLING MEADOWS IL
60008-1261
US

IV. Provider business mailing address

2280 HICKS RD
ROLLING MEADOWS IL
60008-1261
US

V. Phone/Fax

Practice location:
  • Phone: 847-477-6355
  • Fax:
Mailing address:
  • Phone: 847-477-6355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-234589
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152.003376
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: