Healthcare Provider Details

I. General information

NPI: 1558003301
Provider Name (Legal Business Name): MRS. TASIA BUFORD-HOWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 S WESTERN AVE STE 2B
CHICAGO IL
60643-3225
US

IV. Provider business mailing address

10232 S PROSPECT AVE APT F
CHICAGO IL
60643-2161
US

V. Phone/Fax

Practice location:
  • Phone: 773-474-9840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.015951
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number2300737
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: