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General NPI Number Information
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NPI Number | 1437639473
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Entity Type | Organization
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Legal Business Name | THAMANI
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 3036 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60618-3539
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Country | US
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Telephone | 773-270-2150
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 N CALIFORNIA AVE STE 7 BOX 220
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City | CHICAGO
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State | IL
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Zip | 60647-6320
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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 | EXECUTIVE ASSISTANT
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Name | JONATHAN WILDT
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Credential |
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Telephone | 217-370-7540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071009493
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License Number State | IL
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