Provider Demographics
NPI:1861118366
Name:EDMON, SABRINA (RBT)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:EDMON
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 1:14327 OAK AVE LOWR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3269
Mailing Address - Country:US
Mailing Address - Phone:219-798-1957
Mailing Address - Fax:
Practice Address - Street 1:1950 W ROSCOE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1030
Practice Address - Country:US
Practice Address - Phone:219-798-1957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
ILRBT-22-220993106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician