Provider Demographics
NPI:1134307804
Name:GORE, TATIA M
Entity Type:Individual
Prefix:MS
First Name:TATIA
Middle Name:M
Last Name:GORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 S LAKE PARK AVE APT 1708B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-2073
Mailing Address - Country:US
Mailing Address - Phone:773-368-8333
Mailing Address - Fax:773-538-4536
Practice Address - Street 1:4850 S LAKE PARK AVE APT 1708B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2073
Practice Address - Country:US
Practice Address - Phone:773-368-8333
Practice Address - Fax:773-538-4536
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant