Healthcare Provider Details

I. General information

NPI: 1376489799
Provider Name (Legal Business Name): DANE CROUSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 W STREAMWOOD BLVD UNIT B
STREAMWOOD IL
60107-4204
US

IV. Provider business mailing address

608 W STREAMWOOD BLVD UNIT B
STREAMWOOD IL
60107-4204
US

V. Phone/Fax

Practice location:
  • Phone: 847-345-4407
  • Fax:
Mailing address:
  • Phone: 847-345-4407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: