MEDICARE: DR. TIFFANY DELL'AQUILA PSY.D.

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	103TC0700X	Clinical Psychologist	071008018	IL

General Provider Information

NPI Number	:	1891192308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANY DELL'AQUILA PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 3592
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-0592
Country	:	US
Telephone Number	:	773-255-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 N CLEVELAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-5602
Country	:	US
Telephone Number	:	773-255-4200
Fax Number	:

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

Provider Enumeration Date	:	11/26/2014
Last Update Date	:	11/26/2014

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