Provider Demographics
NPI:1619484433
Name:TARAWNEH, MOHAMMED (EDD, CADC)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:
Last Name:TARAWNEH
Suffix:
Gender:M
Credentials:EDD, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10436 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2282
Mailing Address - Country:US
Mailing Address - Phone:708-444-0304
Mailing Address - Fax:708-377-3960
Practice Address - Street 1:10436 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2282
Practice Address - Country:US
Practice Address - Phone:708-444-0304
Practice Address - Fax:708-377-3960
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)