Provider Demographics
NPI:1740839497
Name:TRAMMELL, TAWANA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TAWANA
Middle Name:
Last Name:TRAMMELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 ROBERTS CT
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2431
Mailing Address - Country:US
Mailing Address - Phone:312-343-1286
Mailing Address - Fax:
Practice Address - Street 1:19630 GOVERNORS HWY STE 8
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2079
Practice Address - Country:US
Practice Address - Phone:312-343-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
IL1490209231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical