Healthcare Provider Details

I. General information

NPI: 1669169470
Provider Name (Legal Business Name): PAIGE DEYOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 NATIONS DR STE 110
GURNEE IL
60031-9175
US

IV. Provider business mailing address

306 JUNIPER RD
ISLAND LAKE IL
60042-9519
US

V. Phone/Fax

Practice location:
  • Phone: 262-748-6130
  • Fax:
Mailing address:
  • Phone: 262-748-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: