Provider Demographics
NPI:1023794864
Name:VIDANA, ARIANA G
Entity type:Individual
Prefix:
First Name:ARIANA
Middle Name:G
Last Name:VIDANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3206
Mailing Address - Country:US
Mailing Address - Phone:312-942-8387
Mailing Address - Fax:312-563-1447
Practice Address - Street 1:325 S PAULINA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3206
Practice Address - Country:US
Practice Address - Phone:312-942-8387
Practice Address - Fax:312-563-1447
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.021068103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist