Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | IL | |
N | 103TC0700X | Clinical Psychologist | IL | |
Y | 103G00000X | Clinical Psychologist | IL | |
Y | 103TC0700X | Clinical Psychologist | IL | |
N | 103TR0400X | Rehabilitation Psychologist | IL |
NPI | 1639235997 |
---|---|
Provider Name | Dr. Deirdre L. Tannen |
First Address | Chicago, IL 60640-2774 |
Second Address | Chicago, IL 60640-2774 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 13/07/2007 |