Provider Demographics
NPI:1962969139
Name:SPIRATOS, VERONICA (EDS, NSCP)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:SPIRATOS
Suffix:
Gender:F
Credentials:EDS, NSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 ORIOLE AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-1008
Mailing Address - Country:US
Mailing Address - Phone:847-745-6557
Mailing Address - Fax:
Practice Address - Street 1:9400 ORIOLE AVE
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-1008
Practice Address - Country:US
Practice Address - Phone:847-745-6557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1141241103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool