Provider Demographics
NPI:1528203007
Name:MARY ENGLUND, PSYD., LLC
Entity Type:Organization
Organization Name:MARY ENGLUND, PSYD., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-639-2777
Mailing Address - Street 1:4320 WINFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4018
Mailing Address - Country:US
Mailing Address - Phone:630-639-2777
Mailing Address - Fax:866-441-1136
Practice Address - Street 1:4320 WINFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-4018
Practice Address - Country:US
Practice Address - Phone:630-639-2777
Practice Address - Fax:866-441-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty