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General NPI Number Information
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NPI Number | 1053874537
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Entity Type | Individual
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Provider Name | TARA MARCOSKI
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Gender | Female
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 1765 N ELSTON AVE STE 206
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City | CHICAGO
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State | IL
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Zip | 60642-1501
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Country | US
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Telephone | 312-399-0370
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Fax |
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Provider Business Mailing Address
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Address Line | 727 BERKSHIRE CT
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-4920
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Country | US
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Telephone |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146.014714
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License Number State | IL
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