MEDICARE: TANIYA WHITE PSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		IL

General Provider Information

NPI Number	:	1285582015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIYA WHITE PSW

Provider Business Mailing Address
First Line	:	13116 S RHODES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60827-1338
Country	:	US
Telephone Number	:	708-738-3297
Fax Number	:

Provider Business Practice Location Address
First Line	:	13116 S RHODES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60827-1338
Country	:	US
Telephone Number	:	708-738-3297
Fax Number	:	708-738-3297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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