Provider Demographics
NPI:1669169470
Name:DEYOUNG, PAIGE
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:DEYOUNG
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 1:306 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:ISLAND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60042-9519
Mailing Address - Country:US
Mailing Address - Phone:262-748-6130
Mailing Address - Fax:
Practice Address - Street 1:1790 NATIONS DR STE 110
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9175
Practice Address - Country:US
Practice Address - Phone:262-748-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health