Provider Demographics
NPI:1821679739
Name:TARLACH, ISABELLA PATRICE
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:PATRICE
Last Name:TARLACH
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 1:827 N PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4363
Mailing Address - Country:US
Mailing Address - Phone:630-363-4406
Mailing Address - Fax:
Practice Address - Street 1:3400 W STONEGATE BLVD STE 101-2109
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1045
Practice Address - Country:US
Practice Address - Phone:331-241-6485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILT642-4159-97132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer