Provider Demographics
NPI:1518014075
Name:TADLOCK, THERESA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:L
Last Name:TADLOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4N276 AVARD RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-1278
Mailing Address - Country:US
Mailing Address - Phone:630-231-7282
Mailing Address - Fax:866-364-7286
Practice Address - Street 1:200 W. HIGGINS ROAD
Practice Address - Street 2:SUITE 312
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3734
Practice Address - Country:US
Practice Address - Phone:847-490-1820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490059631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical