Provider Demographics
NPI:1154063204
Name:ZIYAD-NAU, TALIAH
Entity Type:Individual
Prefix:
First Name:TALIAH
Middle Name:
Last Name:ZIYAD-NAU
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 1:2 QUAYSIDE CT
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6213
Mailing Address - Country:US
Mailing Address - Phone:224-305-3755
Mailing Address - Fax:
Practice Address - Street 1:2 QUAYSIDE CT
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-6213
Practice Address - Country:US
Practice Address - Phone:224-305-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.013921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional