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General NPI Number Information
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NPI Number | 1023960630
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Entity Type | Individual
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Provider Name | EDINA SETSUKO TAERBAUM
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Gender | Female
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Dates
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Enumeration Date | 02/14/2026
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Last Update Date | 02/14/2026
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Provider Practice Location Address
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Address Line | 3110 W GRAND AVE
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City | CHICAGO
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State | IL
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Zip | 60622-4324
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Country | US
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Telephone | 847-909-3981
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Fax |
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Provider Business Mailing Address
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Address Line | 7831 KILDARE AVE
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City | SKOKIE
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State | IL
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Zip | 60076-3515
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Country | US
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Telephone | 847-909-3981
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.118976
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License Number State | IL
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