Provider Demographics
NPI:1245411156
Name:ROBINSON, TRISTA D (BS, MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:TRISTA
Middle Name:D
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:BS, MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FOREST PL
Mailing Address - Street 2:UNIT P36
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1145
Mailing Address - Country:US
Mailing Address - Phone:312-497-9876
Mailing Address - Fax:
Practice Address - Street 1:100 FOREST PL
Practice Address - Street 2:UNIT P36
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1145
Practice Address - Country:US
Practice Address - Phone:312-497-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities