Healthcare Provider Details

I. General information

NPI: 1689311805
Provider Name (Legal Business Name): KAYLEE LYNNE TANJIC LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E WACKER DR STE 2102
CHICAGO IL
60601-5314
US

IV. Provider business mailing address

303 E WACKER DR STE 2102
CHICAGO IL
60601-5314
US

V. Phone/Fax

Practice location:
  • Phone: 312-736-1776
  • Fax:
Mailing address:
  • Phone: 312-736-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.024117
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: