Provider Demographics
NPI:1558640193
Name:TAITEL, ERYNN JENNIFER (MED)
Entity type:Individual
Prefix:MRS
First Name:ERYNN
Middle Name:JENNIFER
Last Name:TAITEL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 DOGWOOD TER
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1819
Mailing Address - Country:US
Mailing Address - Phone:224-628-9716
Mailing Address - Fax:
Practice Address - Street 1:344 DOGWOOD TER
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1819
Practice Address - Country:US
Practice Address - Phone:224-628-9716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-14
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist