Provider Demographics
NPI:1720252703
Name:GUZAK, AMBER N (BA, MBA, MA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:N
Last Name:GUZAK
Suffix:
Gender:F
Credentials:BA, MBA, MA
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:N
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:4255 142ND ST
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60445-2307
Mailing Address - Country:US
Mailing Address - Phone:708-272-4470
Mailing Address - Fax:
Practice Address - Street 1:4255 142ND ST
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60445-2307
Practice Address - Country:US
Practice Address - Phone:708-272-4470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILG22001481631222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist