MEDICARE: SYDNEY TALAVERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180.013290	IL
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1174976567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY TALAVERA

Provider Business Mailing Address
First Line	:	19201 S LA GRANGE RD
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-8368
Country	:	US
Telephone Number	:	708-847-8017
Fax Number	:

Provider Business Practice Location Address
First Line	:	19201 S LA GRANGE RD
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-8368
Country	:	US
Telephone Number	:	708-847-8017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	05/18/2026

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Directions to “ SYDNEY TALAVERA ” Practice Location

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