1902286974 NPI number — DR. TERRY ANN DORNAK VILORIA PSY.D.

Table of content: DR. TERRY ANN DORNAK VILORIA PSY.D. (NPI 1902286974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902286974 NPI number — DR. TERRY ANN DORNAK VILORIA PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILORIA
Provider First Name:
TERRY ANN
Provider Middle Name:
DORNAK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DORNAK
Provider Other First Name:
TERRY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1902286974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8941 MARMORA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORTON GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60053-2448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
872-999-0542
Provider Business Mailing Address Fax Number:
847-972-6445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1603 ORRINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201-3841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
872-999-0542
Provider Business Practice Location Address Fax Number:
847-972-6445
Provider Enumeration Date:
06/04/2015

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: 103TC0700X , with the licence number:  071009088 , 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: 111670900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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