Healthcare Provider Details

I. General information

NPI: 1811207897
Provider Name (Legal Business Name): BERNADETTE TALLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6066 159TH ST
OAK FOREST IL
60452-2904
US

IV. Provider business mailing address

2700 W HIGGINS RD STE 120
HOFFMAN ESTATES IL
60169-2006
US

V. Phone/Fax

Practice location:
  • Phone: 708-687-4974
  • Fax:
Mailing address:
  • Phone: 847-843-1900
  • Fax: 847-843-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: