1679721880 NPI number — MONIQUE CLEMINSON, PSY.D., P.C.

Table of content: (NPI 1679721880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679721880 NPI number — MONIQUE CLEMINSON, PSY.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONIQUE CLEMINSON, PSY.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679721880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9933 LAWLER AVE
Provider Second Line Business Mailing Address:
SUITE 324
Provider Business Mailing Address City Name:
SKOKIE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60077-3703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-673-9433
Provider Business Mailing Address Fax Number:
847-673-9431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9933 LAWLER AVE
Provider Second Line Business Practice Location Address:
SUITE 324
Provider Business Practice Location Address City Name:
SKOKIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60077-3703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-673-9433
Provider Business Practice Location Address Fax Number:
847-673-9431
Provider Enumeration Date:
08/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
MONIQUE
Authorized Official Middle Name:
E. CLEMINSON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-673-9433

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  071007070 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1932231461 . This is a "TPE I NPI (MONIQUE CLEMINSON)" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com