Provider Demographics
NPI:1811717499
Name:JOSON, VICTORIA KAY
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:KAY
Last Name:JOSON
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 1:8145 RIVER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2645
Mailing Address - Country:US
Mailing Address - Phone:224-470-1111
Mailing Address - Fax:
Practice Address - Street 1:1736 SETON RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1341
Practice Address - Country:US
Practice Address - Phone:847-757-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician