Provider Demographics
NPI:1396137014
Name:ZHAO, TANG TANYA (PSYD)
Entity type:Individual
Prefix:DR
First Name:TANG
Middle Name:TANYA
Last Name:ZHAO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:TANG
Other - Middle Name:TANYA
Other - Last Name:NORTON-ZHAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1238 W PRATT BLVD
Mailing Address - Street 2:1B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4398
Mailing Address - Country:US
Mailing Address - Phone:312-593-6964
Mailing Address - Fax:
Practice Address - Street 1:1238 W PRATT BLVD
Practice Address - Street 2:1B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-4398
Practice Address - Country:US
Practice Address - Phone:312-593-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008940103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist