Provider Demographics
NPI:1164739728
Name:WEIGLE, LAUREN LEN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LEN
Last Name:WEIGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:LEN
Other - Last Name:BUDREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:439 JUSTINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2220
Mailing Address - Country:US
Mailing Address - Phone:765-404-4563
Mailing Address - Fax:
Practice Address - Street 1:439 JUSTINE AVE
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2220
Practice Address - Country:US
Practice Address - Phone:765-404-4563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008967225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist