Provider Demographics
NPI:1922242486
Name:DAMPER, TIARA (DT)
Entity Type:Individual
Prefix:MS
First Name:TIARA
Middle Name:
Last Name:DAMPER
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9449 S KEDZIE AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2325
Mailing Address - Country:US
Mailing Address - Phone:773-445-2195
Mailing Address - Fax:773-445-2195
Practice Address - Street 1:9449 S KEDZIE AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2325
Practice Address - Country:US
Practice Address - Phone:773-445-2195
Practice Address - Fax:773-445-2195
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist