Provider Demographics
NPI:1881955037
Name:PRONGER, GREGORY E II
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:E
Last Name:PRONGER
Suffix:II
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 1:1005 W LARAWAY RD STE 230
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-4117
Mailing Address - Country:US
Mailing Address - Phone:815-717-1700
Mailing Address - Fax:
Practice Address - Street 1:1005 W LARAWAY RD STE 230
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-4117
Practice Address - Country:US
Practice Address - Phone:815-717-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst