Individual
TARA CHILDRESS-JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLPA
Contact information
Practice address
8819 S FAIRFIELD AVE, EVERGREEN PARK, IL 60805-1144
(312) 758-1463
Mailing address
8819 S FAIRFIELD AVE, EVERGREEN PARK, IL 60805-1144
(312) 758-1463
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
217000240
IL
Other
Enumeration date
06/28/2016
Last updated
06/28/2016
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