Provider Demographics
NPI:1518195510
Name:CHAMBERS, TRESA J (CSA)
Entity Type:Individual
Prefix:
First Name:TRESA
Middle Name:J
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449-0309
Mailing Address - Country:US
Mailing Address - Phone:708-534-2168
Mailing Address - Fax:708-534-2174
Practice Address - Street 1:1250 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1180
Practice Address - Country:US
Practice Address - Phone:630-209-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL98-139174400000X
IL238.000272246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No174400000XOther Service ProvidersSpecialist