IndividualActive
Domonicque Tatum, EDD, LCSW
NPI 1629593173 · Clinical Social Worker · Markham, IL
Provider details
- NPI number
- 1629593173
- Entity type
- Individual
- Primary specialty
- Clinical Social WorkerBehavioral Health & Social Service Providers
- Credential
- EDD, LCSW
- Sex
- Male
- Sole proprietor
- Yes
- License
- 149.017448 (IL)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Practice location
16300 Kedzie Ave
Markham, IL 60428-5508
Phone: (571) 282-5193
Approximate (ZIP-level) locationGet directions
Mailing address
16300 Kedzie Ave
Markham, IL 60428-5508
Registry dates
- Enumerated
- 2017-08-06
- Last updated
- 2022-07-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.