MEDICARE: MRS. TAMARA JANE MAYNARD-ROBBINS

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	235Z00000X	Speech-Language Pathologist	146.014102	IL

General Provider Information

NPI Number	:	1285142828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMARA JANE MAYNARD-ROBBINS

Provider Business Mailing Address
First Line	:	119 E ASH ST
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-2603
Country	:	US
Telephone Number	:	630-613-9034
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 N WOOD DALE RD
Second Line	:
City	:	WOOD DALE
State	:	IL
Zip	:	60191-1572
Country	:	US
Telephone Number	:	630-766-6210
Fax Number	:

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

Provider Enumeration Date	:	01/17/2018
Last Update Date	:	01/17/2018

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Directions to “ MRS. TAMARA JANE MAYNARD-ROBBINS ” Practice Location

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