Individual
TYRONE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5910 W DIVISION ST, CHICAGO, IL 60651-1031
(773) 777-7112
(773) 887-3300
Mailing address
5910 W DIVISION ST, CHICAGO, IL 60651-1031
(773) 777-7112
(773) 887-3300
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11457
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36-3297629
—
IL
Enumeration date
04/25/2018
Last updated
04/25/2018
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