Provider Demographics
NPI:1528562139
Name:MERGENTHALER, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MERGENTHALER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 HAWLEY ST STE 5
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3653
Mailing Address - Country:US
Mailing Address - Phone:847-549-2235
Mailing Address - Fax:
Practice Address - Street 1:142 HAWLEY ST STE 5
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3653
Practice Address - Country:US
Practice Address - Phone:847-549-2235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178009999101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor