Deanne Marie Gustafson
Individual provider Active NPI School Psychologist · La Grange, IL
NPI 1104423409 · NPPES record last updated Oct 8, 2020
Key facts
- NPI
- 1104423409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Psychologist 103TS0200X
- License
- 1884039 (IL)
- Practice address
- 1301 W Cossitt Ave
La Grange, IL 60525-2145 - Phone
- (708) 354-5730
- NPI assigned
- Oct 8, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1884039 | IL | MD | School Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lagrange Area Dept Spec Ed | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 1884039 | IL | Yes |
Addresses
Primary practice location
1301 W Cossitt Ave
La Grange, IL 60525-2145
Mailing address
17200 Teakwood Dr
Tinley Park, IL 60487-5406
Phone (708) 536-8874
Other providers in La Grange, IL
- Mallory Greenbank
- Kimberly Allison Gregoriou
- William H Gros
- Tammy Michele Gross-McCoy
- Jennifer M Gula
- John Nagle Hackett
- Afshan Hafiz Ahmed
- Bruce William Hallmann
- Laura Hamilton
- Neive Hanak
All providers in La Grange, IL · School Psychologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.