Healthcare Provider Details

I. General information

NPI: 1649181124
Provider Name (Legal Business Name): VIANKA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 LAKEVIEW PKWY STE 150
VERNON HILLS IL
60061-1839
US

IV. Provider business mailing address

38455 N SHERIDAN RD LOT 857
BEACH PARK IL
60087-1727
US

V. Phone/Fax

Practice location:
  • Phone: 187-748-6414
  • Fax:
Mailing address:
  • Phone: 708-421-4495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: