Provider Demographics
NPI:1720383839
Name:TENGLIN, GINA ANNE
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:ANNE
Last Name:TENGLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:ANNE
Other - Last Name:RUBEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:4980 N MARINE DR APT 235
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3930
Mailing Address - Country:US
Mailing Address - Phone:847-845-6647
Mailing Address - Fax:
Practice Address - Street 1:4980 N MARINE DR APT 235
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3930
Practice Address - Country:US
Practice Address - Phone:847-845-6647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist