Healthcare Provider Details

I. General information

NPI: 1942992466
Provider Name (Legal Business Name): STEPHANIE ANNE MAKALINTAL TARIGA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

6623 N FRANCISCO AVE
CHICAGO IL
60645-4305
US

V. Phone/Fax

Practice location:
  • Phone: 224-844-6484
  • Fax:
Mailing address:
  • Phone: 773-470-5628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.029759
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.109402
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: