Healthcare Provider Details

I. General information

NPI: 1518208974
Provider Name (Legal Business Name): DANIELLE L GUADARRAMA L.M.T, CMLDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CHATHAM RD STE N
SPRINGFIELD IL
62704-4188
US

IV. Provider business mailing address

2501 CHATHAM RD STE N
SPRINGFIELD IL
62704-4188
US

V. Phone/Fax

Practice location:
  • Phone: 224-376-9798
  • Fax:
Mailing address:
  • Phone: 224-376-9798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227015327
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: