Provider Demographics
NPI:1629585526
Name:TIEHEN, BRITTNEY (EDS)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:TIEHEN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8151 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-3136
Mailing Address - Country:US
Mailing Address - Phone:708-456-8848
Mailing Address - Fax:
Practice Address - Street 1:8151 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-3136
Practice Address - Country:US
Practice Address - Phone:708-456-8848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool