Healthcare Provider Details

I. General information

NPI: 1154557510
Provider Name (Legal Business Name): TAO LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 NAPERVILLE WHEATON RD STE 209F
NAPERVILLE IL
60563-1558
US

IV. Provider business mailing address

1555 NAPER VL WHEATON RD STE 209F
NAPERVILLE IL
60563-1558
US

V. Phone/Fax

Practice location:
  • Phone: 630-283-8111
  • Fax:
Mailing address:
  • Phone: 630-877-6668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20043235A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20043235A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071010500
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071010500
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: