Individual
AMANDA TANAKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1128 HARRISON ST APT 16, OAK PARK, IL 60304-1072
(708) 860-5560
Mailing address
1128 HARRISON ST APT 16, OAK PARK, IL 60304-1072
(708) 860-5560
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
09/08/2014
Last updated
09/08/2014
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