Provider Demographics
NPI:1043758089
Name:ENGSTRAND GUCA PC
Entity Type:Organization
Organization Name:ENGSTRAND GUCA PC
Other - Org Name:PARENT INFANT COMMUNICATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGSTRAND-GUCA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MHS
Authorized Official - Phone:708-334-8139
Mailing Address - Street 1:145 DURHAM DR
Mailing Address - Street 2:
Mailing Address - City:STEGER
Mailing Address - State:IL
Mailing Address - Zip Code:60475-1915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 DURHAM DR
Practice Address - Street 2:
Practice Address - City:STEGER
Practice Address - State:IL
Practice Address - Zip Code:60475-1915
Practice Address - Country:US
Practice Address - Phone:708-334-8139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009331252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency