Provider Demographics
NPI:1922541945
Name:MCLAURIN, DEANDRE
Entity Type:Individual
Prefix:
First Name:DEANDRE
Middle Name:
Last Name:MCLAURIN
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 1:228 DESPLAINES AVE
Mailing Address - Street 2:APT. 401
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130
Mailing Address - Country:US
Mailing Address - Phone:815-354-7287
Mailing Address - Fax:
Practice Address - Street 1:228 DES PLAINES AVE
Practice Address - Street 2:APT. 401
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1271
Practice Address - Country:US
Practice Address - Phone:815-354-7287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst