Provider Demographics
NPI:1912037938
Name:TAMBORSKI, JACQUELINE MARIE (LCSW,BCD)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MARIE
Last Name:TAMBORSKI
Suffix:
Gender:F
Credentials:LCSW,BCD
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Mailing Address - Street 1:15010 S RAVINIA AVE
Mailing Address - Street 2:SUITE 19
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3162
Mailing Address - Country:US
Mailing Address - Phone:773-320-3054
Mailing Address - Fax:708-403-3246
Practice Address - Street 1:11853 SOMERSET RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-1424
Practice Address - Country:US
Practice Address - Phone:773-320-3054
Practice Address - Fax:708-403-3246
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical