Provider Demographics
NPI:1518208974
Name:GUADARRAMA, DANIELLE L (LMT, CMT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:L
Last Name:GUADARRAMA
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 GUNDERSEN DR APT 501
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-3026
Mailing Address - Country:US
Mailing Address - Phone:224-762-4737
Mailing Address - Fax:
Practice Address - Street 1:545 GUNDERSEN DR APT 501
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-3026
Practice Address - Country:US
Practice Address - Phone:224-762-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227015327225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist