Provider Demographics
NPI:1558954826
Name:SEEHUSEN, GREGORY JON
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JON
Last Name:SEEHUSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2484
Mailing Address - Country:US
Mailing Address - Phone:815-517-0825
Mailing Address - Fax:
Practice Address - Street 1:1211 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2484
Practice Address - Country:US
Practice Address - Phone:815-517-0825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health