Healthcare Provider Details

I. General information

NPI: 1972437234
Provider Name (Legal Business Name): TIANA ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2338 LEMAY FERRY RD
SAINT LOUIS MO
63125-3127
US

IV. Provider business mailing address

521 WASHINGTON ST
VENICE IL
62090-1121
US

V. Phone/Fax

Practice location:
  • Phone: 314-793-5141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1395361
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: