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General NPI Number Information
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NPI Number | 1215745567
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Entity Type | Individual
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Provider Name | KATRINA P ROBERTS
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Gender | Female
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 8618 W CATALPA AVE STE 1106
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City | CHICAGO
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State | IL
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Zip | 60656-1108
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Country | US
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Telephone | 872-810-9312
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Fax |
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Provider Business Mailing Address
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Address Line | 7215 S PEORIA ST
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City | CHICAGO
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State | IL
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Zip | 60621-1633
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Country | US
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Telephone | 773-707-2880
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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 |
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License Number State |
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