Provider Demographics
NPI:1548658222
Name:TADLOCK & ASSOCIATES, INC.
Entity type:Organization
Organization Name:TADLOCK & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:TADLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-490-1820
Mailing Address - Street 1:4N276 AVARD RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-1278
Mailing Address - Country:US
Mailing Address - Phone:847-490-1820
Mailing Address - Fax:866-364-7286
Practice Address - Street 1:200 W HIGGINS RD
Practice Address - Street 2:SUITE 312
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3718
Practice Address - Country:US
Practice Address - Phone:847-490-1820
Practice Address - Fax:866-364-7286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0059631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty