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General NPI Number Information
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NPI Number | 1679558571
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Entity Type | Individual
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Provider Name | MICHELE L TANTILLO LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 357 MEADOWLARK DRIVE
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City | BOLINGBROOK
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State | IL
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Zip | 60440
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Country | US
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Telephone | 847-338-8268
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Fax | 847-338-8268
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Provider Business Mailing Address
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Address Line | 357 MEADOWLARK DR
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4980
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Country | US
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Telephone | 847-338-8268
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Fax | 847-338-8268
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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 | 149007488
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.007488
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License Number State | IL
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