Healthcare Provider Details

I. General information

NPI: 1508760687
Provider Name (Legal Business Name): MARINA DZHEMAKULOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 LANGLEY CIR
GLENVIEW IL
60026-7736
US

IV. Provider business mailing address

203 KEDZIE ST APT 1F
EVANSTON IL
60202-2449
US

V. Phone/Fax

Practice location:
  • Phone: 224-999-2952
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: