Provider Demographics
NPI:1366789786
Name:POORVU, TABITHA ANN (MS, CGC)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:ANN
Last Name:POORVU
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:ANN
Other - Last Name:ABRAZINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:730 S CLARK ST
Mailing Address - Street 2:APT 2512
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1743
Mailing Address - Country:US
Mailing Address - Phone:774-239-1730
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:SUITE 1230
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-477-2978
Practice Address - Fax:312-981-4404
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL247000044170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS