Healthcare Provider Details

I. General information

NPI: 1316890429
Provider Name (Legal Business Name): TARA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 BUTTERFIELD RD
DOWNERS GROVE IL
60515-1050
US

IV. Provider business mailing address

1910 HARWARDEN ST
WHEATON IL
60187-5825
US

V. Phone/Fax

Practice location:
  • Phone: 630-537-0941
  • Fax:
Mailing address:
  • Phone: 630-537-0984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: