Provider Demographics
NPI:1528482544
Name:TATUM BLAKELEY, TAMMIE TERAE
Entity type:Individual
Prefix:
First Name:TAMMIE TERAE
Middle Name:
Last Name:TATUM BLAKELEY
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 1:6006 159TH ST BLDG C
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-2904
Mailing Address - Country:US
Mailing Address - Phone:708-535-7320
Mailing Address - Fax:708-535-7571
Practice Address - Street 1:6006 159TH ST BLDG C
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2904
Practice Address - Country:US
Practice Address - Phone:708-535-7320
Practice Address - Fax:708-535-7571
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2024-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst