Provider Demographics
NPI:1467812743
Name:TARTT, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:TARTT
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 1:320 E 21ST ST
Mailing Address - Street 2:317
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3190
Mailing Address - Country:US
Mailing Address - Phone:312-401-1988
Mailing Address - Fax:312-412-4915
Practice Address - Street 1:818 S WOLCOTT AVE
Practice Address - Street 2:800 (MC 579)
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3724
Practice Address - Country:US
Practice Address - Phone:312-996-8268
Practice Address - Fax:312-413-4915
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health