Provider Demographics
NPI:1053169052
Name:LINDSTROM, TARA MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:MARIE
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:MARIE
Other - Last Name:FANTETTI-LINDSTROM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:4009 LIBERTY BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1317
Mailing Address - Country:US
Mailing Address - Phone:928-380-5824
Mailing Address - Fax:
Practice Address - Street 1:2005 BLOOMINGDALE RD STE B
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-2151
Practice Address - Country:US
Practice Address - Phone:630-383-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist