Provider Demographics
NPI:1902247810
Name:ARVIDSON, ROBERT W
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:ARVIDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 BERN CT
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-1370
Mailing Address - Country:US
Mailing Address - Phone:847-566-5168
Mailing Address - Fax:847-566-5178
Practice Address - Street 1:998 EAST MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-0000
Practice Address - Country:US
Practice Address - Phone:847-566-5168
Practice Address - Fax:847-566-5178
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008426101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional