Provider Demographics
NPI:1285142828
Name:MAYNARD-ROBBINS, TAMARA JANE
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:JANE
Last Name:MAYNARD-ROBBINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E ASH ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2603
Mailing Address - Country:US
Mailing Address - Phone:630-613-9034
Mailing Address - Fax:
Practice Address - Street 1:655 N WOOD DALE RD
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1572
Practice Address - Country:US
Practice Address - Phone:630-766-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.014102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist