Provider Demographics
NPI:1972392009
Name:WHITE, MARGUARITE NICOLE
Entity type:Individual
Prefix:
First Name:MARGUARITE
Middle Name:NICOLE
Last Name:WHITE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LESTER RD
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-2012
Mailing Address - Country:US
Mailing Address - Phone:773-329-9306
Mailing Address - Fax:
Practice Address - Street 1:5113 S HARPER AVE STE 2C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4119
Practice Address - Country:US
Practice Address - Phone:833-717-4244
Practice Address - Fax:833-717-4244
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician