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Individual

DR. DOMONICQUE TATUM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
EDD, LCSW

Contact information

Practice address
16300 KEDZIE AVE, MARKHAM, IL 60428-5508
(571) 282-5193
Mailing address
16300 KEDZIE AVE, MARKHAM, IL 60428-5508
(571) 282-5193

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.017448
IL

Other

Enumeration date
08/06/2017
Last updated
07/21/2022
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