Provider Demographics
NPI:1457241879
Name:VIDENOVIC, MILICA (RBT)
Entity type:Individual
Prefix:
First Name:MILICA
Middle Name:
Last Name:VIDENOVIC
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2968
Mailing Address - Country:US
Mailing Address - Phone:736-550-6907
Mailing Address - Fax:
Practice Address - Street 1:8111 SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2968
Practice Address - Country:US
Practice Address - Phone:773-655-0690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-25-408707106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician