Provider Demographics
NPI:1962480111
Name:GUST, DEBORAH A (MA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:GUST
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 OLD GRAND AVENUE
Mailing Address - Street 2:STE. 107C
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3393
Mailing Address - Country:US
Mailing Address - Phone:847-662-2174
Mailing Address - Fax:847-662-2159
Practice Address - Street 1:4343 OLD GRAND AVENUE
Practice Address - Street 2:SUITE 107C
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3393
Practice Address - Country:US
Practice Address - Phone:847-662-2174
Practice Address - Fax:847-662-2159
Is Sole Proprietor?:No
Enumeration Date:2006-01-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional