Provider Demographics
NPI:1295357515
Name:VIOLET THEODOS, PH.D. PLLC
Entity Type:Organization
Organization Name:VIOLET THEODOS, PH.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIOLET
Authorized Official - Middle Name:
Authorized Official - Last Name:THEODOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-233-4740
Mailing Address - Street 1:1215 W HUNTER CT
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-1125
Mailing Address - Country:US
Mailing Address - Phone:630-233-4740
Mailing Address - Fax:
Practice Address - Street 1:1550 SPRING RD STE 220
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1362
Practice Address - Country:US
Practice Address - Phone:630-233-4740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty