Individual
DEANNE MARIE GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 W COSSITT AVE, LA GRANGE, IL 60525-2145
(708) 354-5730
Mailing address
17200 TEAKWOOD DR, TINLEY PARK, IL 60487-5406
(708) 536-8874
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
1884039
IL
Other
Enumeration date
10/08/2020
Last updated
10/08/2020
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