Individual
VICTORIA LISA CODISPOTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4232 CARTTER RD, KELL, IL 62853-1148
(618) 292-3437
(618) 242-8240
Mailing address
4232 CARTTER RD, KELL, IL 62853-1148
(618) 292-3437
(618) 242-8240
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036108109
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036108109
—
IL
Enumeration date
06/04/2006
Last updated
03/20/2025
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