Provider Demographics
NPI:1679770531
Name:ROBINSON, MONIQUE SHAVON (MR16981203P)
Entity Type:Individual
Prefix:MISS
First Name:MONIQUE
Middle Name:SHAVON
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MR16981203P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:16001 S MARSHFIELD
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-7368
Mailing Address - Country:US
Mailing Address - Phone:708-333-6349
Mailing Address - Fax:
Practice Address - Street 1:16001 MARSHFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4920
Practice Address - Country:US
Practice Address - Phone:708-333-6349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILMR16981203P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMR16981203POtherDT