Provider Demographics
NPI:1639686538
Name:GLUSCIC, LINDSAY M LANG
Entity Type:Individual
Prefix:
First Name:LINDSAY M
Middle Name:LANG
Last Name:GLUSCIC
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 1:915 PETER AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-3733
Mailing Address - Country:US
Mailing Address - Phone:708-966-7414
Mailing Address - Fax:
Practice Address - Street 1:915 PETER AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-3733
Practice Address - Country:US
Practice Address - Phone:708-966-7414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health