Provider Demographics
NPI:1922771005
Name:EXPRESSION AND ESPRESSO, LLC
Entity Type:Organization
Organization Name:EXPRESSION AND ESPRESSO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:847-772-7469
Mailing Address - Street 1:18 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-2829
Mailing Address - Country:US
Mailing Address - Phone:847-772-7469
Mailing Address - Fax:
Practice Address - Street 1:18 SPRING ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-2829
Practice Address - Country:US
Practice Address - Phone:847-772-7469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health