=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982198891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOSAIC GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2018
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 895 SUMAC RD
-----------------------------------------------------
City | HIGHLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60035-3840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-799-9351
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 895 SUMAC RD
-----------------------------------------------------
City | HIGHLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60035-3840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-799-9351
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | VERONICA VYAZOVSKY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-799-9351
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------