Provider Demographics
NPI:1417756560
Name:MISTER, TAIJA
Entity type:Individual
Prefix:
First Name:TAIJA
Middle Name:
Last Name:MISTER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 STIRLING LN APT 1912
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-3184
Mailing Address - Country:US
Mailing Address - Phone:773-818-2010
Mailing Address - Fax:
Practice Address - Street 1:7 STIRLING LN APT 1912
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-3184
Practice Address - Country:US
Practice Address - Phone:773-818-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician