Provider Demographics
NPI:1417083569
Name:AVNI, TAMAR (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:
Last Name:AVNI
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 N DOVER ST
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4687
Mailing Address - Country:US
Mailing Address - Phone:773-502-6225
Mailing Address - Fax:773-561-6554
Practice Address - Street 1:4711 N DOVER ST
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4687
Practice Address - Country:US
Practice Address - Phone:773-502-6225
Practice Address - Fax:773-561-6554
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist