Provider Demographics
NPI:1932231461
Name:CLEMINSON, MONIQUE ELIZABETH CLEMINSON
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ELIZABETH CLEMINSON
Last Name:CLEMINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:CLEMINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:9933 LAWLER AVE
Mailing Address - Street 2:SUITE 324
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3703
Mailing Address - Country:US
Mailing Address - Phone:847-673-9433
Mailing Address - Fax:847-673-9431
Practice Address - Street 1:9933 LAWLER AVE
Practice Address - Street 2:SUITE 324
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3703
Practice Address - Country:US
Practice Address - Phone:847-673-9433
Practice Address - Fax:847-673-9431
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007070103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical