Provider Demographics
NPI:1437926920
Name:TICHENOR, CALEB TODD (HIS)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:TODD
Last Name:TICHENOR
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 N SHEFFIELD AVE APT 514
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-0065
Mailing Address - Country:US
Mailing Address - Phone:812-470-9403
Mailing Address - Fax:
Practice Address - Street 1:3220 VOLLMER RD
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1122
Practice Address - Country:US
Practice Address - Phone:708-283-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3510237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist