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1104423409
DEANNE MARIE GUSTAFSON
LA GRANGE, IL
NPI
1104423409
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
103TS0200X Psychologist, School
(Licence: IL 1884039)
Enumeration Date
2020-10-08
Last Update Date
2020-10-08
Business Address
DEANNE MARIE GUSTAFSON
1301 W COSSITT AVE
LA GRANGE, IL 60525-2145
Phone number: 708-354-5730
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Mailing Address
DEANNE MARIE GUSTAFSON
17200 TEAKWOOD DR
TINLEY PARK, IL 60487-5406
Phone number: 708-536-8874
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