Provider Demographics
NPI:1023541521
Name:NOWAK, TAMARA M (LSW, CADC, JD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:M
Last Name:NOWAK
Suffix:
Gender:F
Credentials:LSW, CADC, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 ATLANTIC AVE
Mailing Address - Street 2:APT A
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-4752
Mailing Address - Country:US
Mailing Address - Phone:847-767-4719
Mailing Address - Fax:
Practice Address - Street 1:2455 DEAN ST.
Practice Address - Street 2:SUITE 3G
Practice Address - City:ST. CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:630-262-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL31619101YA0400X
IL150.102322104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)