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General NPI Number Information
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NPI Number | 1225272388
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Entity Type | Individual
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Provider Name | TIJEN DYSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 1322 OAKTON ST
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City | EVANSTON
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State | IL
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Zip | 60202-2719
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Country | US
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Telephone | 847-868-3298
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Fax |
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Provider Business Mailing Address
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Address Line | 7104 N DAMEN AVE APT 1
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City | CHICAGO
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State | IL
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Zip | 60645-2450
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Country | US
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Telephone | 773-404-6422
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149-013091
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License Number State | IL
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