Healthcare Provider Details

I. General information

NPI: 1720252703
Provider Name (Legal Business Name): AMBER N GUZAK B.A., M.B.A., M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMBER N STEVENS B.A.

II. Dates (important events)

Enumeration Date: 04/21/2008
Last Update Date: 04/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 142ND ST
CRESTWOOD IL
60445-2307
US

IV. Provider business mailing address

4255 142ND ST
CRESTWOOD IL
60445-2307
US

V. Phone/Fax

Practice location:
  • Phone: 708-272-4470
  • Fax:
Mailing address:
  • Phone: 708-272-4470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberG22001481631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: