Individual
DIANE MAYE TABILO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
28W542 BATAVIA RD, WARRENVILLE, IL 60555-3009
(630) 393-7057
(630) 393-7029
Mailing address
122 W LIBERTY DR, WHEATON, IL 60187-5124
(630) 682-1910
(630) 682-3094
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149019706
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149019706
LICENSE NUMBER
IL
Enumeration date
01/18/2018
Last updated
01/18/2018
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