Provider Demographics
NPI:1760363220
Name:DAVIS ROBINSON, TYWANA EVETTE
Entity type:Individual
Prefix:
First Name:TYWANA
Middle Name:EVETTE
Last Name:DAVIS ROBINSON
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 1:7737 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-4611
Mailing Address - Country:US
Mailing Address - Phone:773-398-7272
Mailing Address - Fax:
Practice Address - Street 1:7737 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-4611
Practice Address - Country:US
Practice Address - Phone:773-398-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150113293104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty