1902037112 NPI number — MISS ROBIN LATRICE KNIGHT L.C.S.W.

Table of content: MISS ROBIN LATRICE KNIGHT L.C.S.W. (NPI 1902037112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902037112 NPI number — MISS ROBIN LATRICE KNIGHT L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNIGHT
Provider First Name:
ROBIN
Provider Middle Name:
LATRICE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

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:
1902037112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10714 S GREEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60643-3820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-568-7459
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
849 MAPLE AVE
Provider Second Line Business Practice Location Address:
SUITE 905
Provider Business Practice Location Address City Name:
HOMEWOOD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60430-2066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-799-5862
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149.013417 , 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)





Copyright © 2007-2025 www.npivalidator.com