Provider Demographics
NPI:1891591632
Name:HUNTER, TANAII (LSW)
Entity type:Individual
Prefix:
First Name:TANAII
Middle Name:
Last Name:HUNTER
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:TANAII
Other - Middle Name:
Other - Last Name:WELLINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:447 N LOMBARD AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2498
Mailing Address - Country:US
Mailing Address - Phone:573-586-1764
Mailing Address - Fax:
Practice Address - Street 1:447 N LOMBARD AVE APT 3
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2498
Practice Address - Country:US
Practice Address - Phone:573-586-1764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1501099261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical