Provider Demographics
NPI:1831441286
Name:EDMOND, NATAKI NIAMBI (MS ED)
Entity type:Individual
Prefix:MRS
First Name:NATAKI
Middle Name:NIAMBI
Last Name:EDMOND
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:MRS
Other - First Name:NATAKI
Other - Middle Name:NIAMBI
Other - Last Name:MUHAMMAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS ED
Mailing Address - Street 1:11660 S OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4745
Mailing Address - Country:US
Mailing Address - Phone:708-845-7245
Mailing Address - Fax:
Practice Address - Street 1:11660 S OAKLEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4745
Practice Address - Country:US
Practice Address - Phone:708-845-7245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist