Individual
DANIEL TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1010 LAKE ST STE 216, OAK PARK, IL 60301-1147
(901) 462-1806
Mailing address
1412 GUNDERSON AVE, BERWYN, IL 60402-1153
(901) 462-1806
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14976959
CAQH
IL
Enumeration date
09/29/2020
Last updated
12/29/2025
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