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General NPI Number Information
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NPI Number | 1164223863
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Entity Type | Individual
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Provider Name | GABRIEL DESHAWN ROBINSON
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Gender | Male
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 4108 FIELDSTONE RD
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City | CHAMPAIGN
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State | IL
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Zip | 61822-8817
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Country | US
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Telephone | 888-308-3728
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 W CLARK ST
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City | CHAMPAIGN
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State | IL
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Zip | 61821-3152
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Country | US
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Telephone | 815-505-4985
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT25-405973
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License Number State | IL
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